Challenges of antimicrobial stewardship among older adults

•The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness.•Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.•AMS interventions are...

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Bibliographic Details
Published in:European journal of internal medicine 2024-06, Vol.124, p.5-13
Main Authors: Alves, Joana, Prendki, Virginie, Chedid, Marie, Yahav, Dafna, Bosetti, Davide, Rello, Jordi
Format: Article
Language:English
Subjects:
Aging
Antimicrobial optimization
Antimicrobial resistance
Elderly
Long-term care facilities
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Summary:•The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness.•Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.•AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.
ISSN:0953-6205
1879-0828
DOI:10.1016/j.ejim.2024.01.009