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Antimicrobial Therapy in Long-Term Care: Controversy, Colonization, and Criteria

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OBJECTIVE: To empower pharmacists to improve the outcomes of residents in long-term care facilities with urinary tract (UTIs) and skin and soft-tissue infections (SSTIs).

DATA SOURCES: Relevant articles published since 1990 to date were found via PubMed regarding: long-term care, urinary tract infection, skin and soft-tissue infection, antimicrobials, multi-drug-resistant organisms, antimicrobial resistance, and dementia. Two additional Web sites were included for pharmacists' resources. A total of 28 sources were used (studies, Web sites, and review articles).

STUDY SELECTION: Sixteen studies were included regarding treatment of suspected infections, antimicrobial resistance of organisms present in long-term care facilities, and interventions previously attempted toward antimicrobial stewardship.

DATA EXTRACTION: The types of infection seen in long-term care facilities were narrowed to UTIs and SSTIs. Data were extracted regarding the type/resistance of bacteria and treatment outcomes.

DATA ANALYSIS: The review demonstrates growing antimicrobial resistance in long-term care for pathogens causing UTIs and SSTIs. The review outlines guidelines for the treatment of such infections, and the incidence of asymptomatic bacteriuria, and subsequent overtreatment. Also included is a discussion of antimicrobial usage in dementia and resources for antimicrobial stewardship.

CONCLUSION: Pharmacists can aid with antimicrobial stewardship in long-term care by educating providers on the need for changes in prescribing habits and the criteria for treating UTIs and SSTIs.
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Keywords: ANTIMICROBIAL RESISTANCE; ANTIMICROBIAL STEWARDSHIP; ASYMPTOMATIC BACTERIURIA; DEMENTIA; GERIATRICS; LONG-TERM CARE; SKIN AND SOFT-TISSUE INFECTIONS; URINARY TRACT INFECTIONS

Document Type: Review Article

Affiliations: Pacific University, School of Pharmacy, Hillsboro, Oregon, USA

Publication date: 2015-09-01

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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