The Outcomes of Antibiotic Stewardship Programs in Nursing Homes: A Systematic Review

Public Deposited
Analytics

Downloadable Content

Download file
Request Version for Screen Reader
Last Modified
  • January 10, 2020
Creator
  • Feldstein, Diana
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
Abstract
  • Antibiotic stewardship programs (ASPs) are coordinated interventions that promote the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs change practices. This systematic review evaluated the literature regarding ASPs in the NH, measuring their effect on final health outcomes (mortality and C. difficile infections), health utilization outcomes (emergency room visits and hospital admissions) and intermediate health outcomes (number of antibiotics prescribed, adherence to recommended guidelines). We searched Pubmed, CINAHL, EMBASE and Cochrane for interventional trials performed in NHs with ASPs measuring the above outcomes. We found 529 studies that met inclusion criteria and included 14 in this review. Five studies were randomized controlled trials, 7 were Before-After studies and 2 were nonrandomized controlled trials. No study found a change in NH mortality or C. difficile infection rates associated with ASPs. No study found a change in emergency room use or hospitalizations. Eight studies found a reduction in antibiotic prescriptions for NH residents of NH with ASPs. Ten studies measured guideline adherence. This review is limited by heterogeneity in study design, intervention types and outcome measures. Overall, this review suggests that ASPs can affect intermediate health outcomes. Further research is needed to conclude that these programs are beneficial in NHs.
Date of publication
Keyword
DOI
Resource type
Rights statement
  • In Copyright
Note
  • Paper type: Systematic review
  • Track: HC&P
Advisor
  • Feltner, Cynthia
Reviewer
  • Sloane, Philip
Degree
  • Master of Public Health
Academic concentration
  • Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
Language
Deposit record
  • dc164169-ea99-43de-af5e-6fddb9605123

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details phlp_entire.doc 2020-01-10 Public Download