Skip to main content
SpringerLink
Log in

Antibiotic Stewardship

  • Reference work entry
  • First Online:
Geriatric Medicine

  • 644 Accesses

Abstract

Antibiotic stewardship is defined as “coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug regimen.” The goal is to achieve optimal clinical outcomes while minimizing toxicity and other adverse events. Of particular interest is reducing the incidence and preventing the spread of antibiotic-resistant infections by organisms such as methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterococci, and Clostridioides difficile.

Antibiotic stewardship should be practiced in hospitals, ambulatory settings, and in post-acute and long-term care. Whatever the setting, it must involve cooperation between clinicians, nurses, and pharmacists; prescribing guidelines and, when appropriate, a formulary; measurement and reporting of antibiotic use and, ideally, guideline adherence; and ongoing quality improvement efforts to improve prescribing.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,199.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,099.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33(4):322–7.

    Article  Google Scholar 

  2. Hughes MA, Dosa DM, Caffrey AR, Appaneal HJ, Jump RLP, Lopes V, LaPlante KL. Antibiograms cannot be used interchangeably between acute care medical centers and affiliated nursing homes. J Am Med Dir Assoc. 2020;21(1):72–7.

    Article  PubMed  Google Scholar 

  3. Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep. 2016;65(No. RR-6):1–12.

    Google Scholar 

  4. NCQA. Required HEDIS® and CAHPS® measures for HEDIS reporting year 2021. https://www.ncqa.org/wp-content/uploads/2020/12/20201218_2021_List_of_Required_Performance_Measures.pdf. Accessed 1 May 2021.

  5. American Geriatric Society. Choosing Wisely. https://www.choosingwisely.org/societies/american-geriatrics-society/. Accessed 1 May 2021.

  6. Dobson EL, Klepser ME, Pogue JM, Labreche MJ, Adams AJ, Gauthier TP, Turner RB, Su CP, Jacobs DM, Suda KJ, SIDP Community Pharmacy Antimicrobial Stewardship Task Force. Outpatient antibiotic stewardship: interventions and opportunities. J Am Pharm Assoc (2003). 2017;57(4):464–73.

    Article  PubMed  Google Scholar 

  7. Patel M, Lee SI, Akyea RK, Grindlay D, Francis N, Levell NJ, et al. A systematic review showing the lack of diagnostic criteria and tools developed for lower limb cellulitis. Br J Dermatol. 2019;181(6):1156–1165.

    Google Scholar 

  8. Weng QY, Raff AB, Cohen JM, Gunasekera N, Okhovat JP, Vedak P, et al. Costs and consequences associated with misdiagnosed lower extremity cellulitis. JAMA Dermatol. 2017;153(2):141–6.

    Article  PubMed  Google Scholar 

  9. Boyko TV, Longaker MT, Yang GP. Review of the current management of pressure ulcers. Adv Wound Care. 2018;7(2):57–67.

    Article  Google Scholar 

  10. Drinka P, Bonham P, Crnich CJ. Swab culture of purulent skin infection to detect infection or colonization with antibiotic-resistant bacteria. J Am Med Dir Assoc. 2012;13(1):75–9.

    Article  PubMed  Google Scholar 

  11. Shlaes DM, Gerding DN, John JF Jr, Craig WA, Bornstein DL, Duncan RA, Eckman MR, Farrer WE, Greene WH, Lorian V, Levy S, McGowan JE Jr, Paul SM, Ruskin J, Tenover FC, Watanakunakorn C. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol. 1997;18(4):275–91.

    Article  CAS  PubMed  Google Scholar 

  12. Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, Sweet RL, Wenzel RP. Quality standard for antimicrobial prophylaxis in surgical procedures. The Infectious Diseases Society of America. Infect Control Hosp Epidemiol. 1994;15(3):182–8.

    Article  CAS  PubMed  Google Scholar 

  13. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev. 2011;24(1):141–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gilbert GL, Kerridge I. Hospital infection control: old problem – evolving challenges. Intern Med J. 2020;50(1):105–7.

    Article  PubMed  Google Scholar 

  15. US Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. Atlanta: US Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.pdf. Accessed 1 May 2021

    Google Scholar 

  16. McKinnell JA, Miller LG, Singh R, Kleinman K, Peterson EM, Evans KD, et al. Prevalence of and factors associated with multidrug resistant organism (MDRO) colonization in 3 nursing homes. Infect Control Hosp Epidemiol. 2016;37(12):1485–8.

    Article  PubMed  Google Scholar 

  17. Federal Register. Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities. October 4, 2016. https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Accessed 1 May 2012.

  18. Sloane PD, Ward K, Weber DJ, Kistler CE, Brown B, Davis K, et al. Can sepsis be detected in the nursing home prior to the need for hospital transfer? J Am Med Dir Assoc. 2018;19(6):492–6.e1.

    Article  PubMed  Google Scholar 

  19. Rowe TA, Jump RLP, Andersen BM, Banach DB, Bryant KA, Doernberg SB, Loeb M, Morgan DJ, Morris AM, Murthy RK, Nace DA, Crnich CJ. Reliability of nonlocalizing signs and symptoms as indicators of the presence of infection in nursing-home residents. Infect Control Hosp Epidemiol. 2022;43(4):417–426.

    Google Scholar 

  20. US Centers for Disease Control and Prevention. Nursing Home Infection Preventionist Training Course. February, 2019. https://www.train.org/cdctrain/training_plan/3814. Accessed 1 May 2021.

  21. Seshadri S, Felsen CB, Sellers CR, Dumyati GK. “There is no one to pick up the pieces”: sustainability of antibiotic stewardship programs in nursing homes. Infect Control Hosp Epidemiol. 2021;42(4):440–7.

    Article  PubMed  Google Scholar 

  22. Felsen CB, Dodds Ashley ES, Barney GR, Nelson DL, Nicholas JA, Yang H, Aydelotte ME, Karlic A, Nicholas NC, Petrone KK, Pine RD, Schabel SL, Medina-Walpole A, Dumyati GK. Reducing fluoroquinolone use and Clostridioides difficile infections in community nursing homes through hospital-nursing home collaboration. J Am Med Dir Assoc. 2020;21(1):55–61.e2.

    Article  PubMed  Google Scholar 

  23. Nace DA, Hanlon JT, Crnich CJ, Drinka PJ, Schweon SJ, Anderson G, Perera S. A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents. JAMA Intern Med. 2020;180(7):944–51.

    Article  PubMed  Google Scholar 

  24. Tandan M, Sloane PD, Ward K, Weber DJ, Vellinga A, Kistler CE, Zimmerman S. Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention. Infect Control Hosp Epidemiol. 2019;40(7):780–6.

    Article  PubMed  Google Scholar 

  25. Monette J, Miller MA, Monette M, Laurier C, Boivin JF, Sourial N, Le Cruguel JP, Vandal A, Cotton-Montpetit M. Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. J Am Geriatr Soc. 2007;55(8):1231–5.

    Article  PubMed  Google Scholar 

  26. Pettersson E, Vernby A, Mölstad S, Lundborg CS. Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? A cluster randomized controlled trial. J Antimicrob Chemother. 2011;66(11):2659–66.

    Article  CAS  PubMed  Google Scholar 

  27. Jump RL, Olds DM, Seifi N, Kypriotakis G, Jury LA, Peron EP, Hirsch AA, Drawz PE, Watts B, Bonomo RA, Donskey CJ. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use. Infect Control Hosp Epidemiol. 2012;33(12):1185–92.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zimmerman S, Sloane PD, Bertrand R, Olsho LE, Beeber A, Kistler C, Hadden L, Edwards A, Weber DJ, Mitchell CM. Successfully reducing antibiotic prescribing in nursing homes. J Am Geriatr Soc. 2014 May;62(5):907–12.

    Article  PubMed  Google Scholar 

  29. Fleet E, Gopal Rao G, Patel B, Cookson B, Charlett A, Bowman C, Davey P. Impact of implementation of a novel antimicrobial stewardship tool on antibiotic use in nursing homes: a prospective cluster randomized control pilot study. J Antimicrob Chemother. 2014;69(8):2265–73.

    Article  CAS  PubMed  Google Scholar 

  30. Van Buul LW, van der Steen JT, Achterberg WP, Schellevis FG, Essink RT, de Greeff SC, Natsch S, Sloane PD, Zimmerman S, Twisk JW, Veenhuizen RB, Hertogh CM. Effect of tailored antibiotic stewardship programmes on the appropriateness of antibiotic prescribing in nursing homes. J Antimicrob Chemother. 2015;70(7):2153–62.

    Article  PubMed  Google Scholar 

  31. Sloane PD, Zimmerman S, Ward K, Kistler CE, Paone D, Weber DJ, Wretman CJ, Preisser JS. A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes. J Am Geriatr Soc. 2020;68(1):46–54.

    Article  PubMed  Google Scholar 

  32. Naughton BJ, Mylotte JM, Ramadan F, Karuza J, Priore RL. Antibiotic use, hospital admissions, and mortality before and after implementing guidelines for nursing home-acquired pneumonia. J Am Geriatr Soc. 2001;49(8):1020–4.

    Article  CAS  PubMed  Google Scholar 

  33. Loeb M, Brazil K, Lohfeld L, McGeer A, Simor A, Stevenson K, Zoutman D, Smith S, Liu X, Walter SD. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomized controlled trial. BMJ. 2005;331(7518):669.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hutt E, Ruscin JM, Corbett K, Radcliff TA, Kramer AM, Williams EM, Liebrecht D, Klenke W, Hartmann S. A multifaceted intervention to implement guidelines improved treatment of nursing home-acquired pneumonia in a state veterans home. J Am Geriatr Soc. 2006;54(11):1694–7004.

    Article  PubMed  Google Scholar 

  35. Zabarsky TF, Sethi AK, Donskey CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control. 2008;36(7):476–80.

    Article  PubMed  Google Scholar 

  36. Linnebur SA, Fish DN, Ruscin JM, Radcliff TA, Oman KS, Fink R, Van Dorsten B, Liebrecht D, Fish R, McNulty M, Hutt E. Impact of a multidisciplinary intervention on antibiotic use for nursing home-acquired pneumonia. Am J Geriatr Pharmacother. 2011;9(6):442–450.e1.

    Article  PubMed  Google Scholar 

  37. Doernberg SB, Dudas V, Trivedi KK. Implementation of an antimicrobial stewardship program targeting residents with urinary tract infections in three community long-term care facilities: a quasi-experimental study using time-series analysis. Antimicrob Resist Infect Control. 2015;4:54.

    Article  PubMed  PubMed Central  Google Scholar 

  38. US Centers for Disease Control and Prevention. The core elements of antibiotic stewardship for nursing homes. Atlanta: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/longtermcare/index.html. Accessed 1 May 2021

    Google Scholar 

  39. Loeb M, Bentley DW, Bradley S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term care facilities: results of a consensus conference. Infect Control Hosp Epidemiol. 2001;22:120–4.

    Article  CAS  PubMed  Google Scholar 

  40. Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33:965–77.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hanlon JT, Perera S, Drinka PJ, Crnich CJ, Schweon SJ, Klein-Fedyshin M, Wessel CB, Saracco S, Anderson G, Mulligan M, Nace DA. The IOU consensus recommendations for empirical therapy of cystitis in nursing home residents. J Am Geriatr Soc. 2019;67(3):539–45.

    Article  PubMed  Google Scholar 

  42. Zarowitz BJ, Allen C, Tangalos E, Ouslander JG. Algorithms promoting antimicrobial stewardship in long-term care. J Am Med Dir Assoc. 2016;17:173–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family Medicine and Program on Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Philip D. Sloane & Christine E. Kistler

  2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Philip D. Sloane & Christine E. Kistler

Authors
  1. Philip D. Sloane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine E. Kistler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip D. Sloane .

Editor information

Editors and Affiliations

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman

  2. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Debra Bakerjian

  3. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Sunny Linnebur

  4. Division of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA

    Sharon Brangman

  5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

  6. Section of Geriatric Medicine, Division of Internal Medicine, Department of Medicine, Cedars-Sinai, Beverly Hills, CA, USA

    Sonja Rosen

Section Editor information

  1. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California, USA

    Debra Bakerjian PhD, APRN, FAAN, FAANP

Rights and permissions

Reprints and permissions

Copyright information

© 2024 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Sloane, P.D., Kistler, C.E. (2024). Antibiotic Stewardship. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_121

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-74720-6_121

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74719-0

  • Online ISBN: 978-3-030-74720-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation