Department of Public Health Sciences and Pediatrics, University of Turin, Torino, Italy.
Department of Public Health Sciences and Pediatrics, Medical Library 'Ferdinando Rossi', University of Turin, Torino, Italy.
J Antimicrob Chemother. 2024 Aug 1;79(8):1748-1761. doi: 10.1093/jac/dkae146.
Long-term care facilities (LTCFs) present specific challenges for the implementation of antimicrobial stewardship (AMS) programmes. A growing body of literature is dedicated to AMS in LTCFs.
We aimed to summarize barriers to the implementation of full AMS programmes, i.e. a set of clinical practices, accompanied by recommended change strategies.
A scoping review was conducted through Ovid-MEDLINE, CINAHL, Embase and Cochrane Central. Studies addressing barriers to the implementation of full AMS programmes in LTCFs were included. Implementation barriers described in qualitative studies were identified and coded, and main themes were identified using a grounded theory approach.
The electronic search revealed 3904 citations overall. Of these, 57 met the inclusion criteria. All selected studies were published after 2012, and the number of references per year progressively increased, reaching a peak in 2020. Thematic analysis of 13 qualitative studies identified three main themes: (A) LTCF organizational culture, comprising (A1) interprofessional tensions, (A2) education provided in silos, (A3) lack of motivation and (A4) resistance to change; (B) resources, comprising (B1) workload and staffing levels, (B2) diagnostics, (B3) information technology resources and (B4) funding; and (C) availability of and access to knowledge and skills, including (C1) surveillance data, (C2) infectious disease/AMS expertise and (C3) data analysis skills.
Addressing inappropriate antibiotic prescribing in LTCFs through AMS programmes is an area of growing interest. Hopefully, this review could be helpful for intervention developers and implementers who want to build on the most recent evidence from the literature.
长期护理机构（LTCF）在实施抗菌药物管理（AMS）计划方面存在特殊挑战。越来越多的文献致力于 LTCF 中的 AMS。
我们旨在总结实施全面 AMS 计划（即一套临床实践，并伴有推荐的变革策略）的障碍。
通过 Ovid-MEDLINE、CINAHL、Embase 和 Cochrane Central 进行了范围综述。纳入了探讨 LTCF 中全面 AMS 计划实施障碍的研究。通过扎根理论方法，确定并编码定性研究中描述的实施障碍，并确定主要主题。
电子检索共显示 3904 条引文。其中，57 项符合纳入标准。所有选定的研究均发表于 2012 年之后，且每年的参考文献数量逐渐增加，在 2020 年达到峰值。对 13 项定性研究的主题分析确定了三个主要主题：（A）长期护理机构组织文化，包括（A1）跨专业紧张关系、（A2）孤岛式教育、（A3）缺乏动力和（A4）抵制变革；（B）资源，包括（B1）工作量和人员配备水平、（B2）诊断、（B3）信息技术资源和（B4）资金；（C）知识和技能的可及性和可获得性，包括（C1）监测数据、（C2）传染病/AMS 专业知识和（C3）数据分析技能。
通过 AMS 计划解决长期护理机构中不适当的抗生素处方问题是一个日益受到关注的领域。希望本综述能为希望在文献中最新证据基础上进一步发展的干预措施开发者和实施者提供帮助。
