Abstract
Background: Antimicrobial Stewardship (AMS) programs are increasingly implemented in healthcare facilities to reduce inappropriate use of antibiotics. Inappropriate use of antimicrobials is one of the leading causes of increasing antimicrobial resistance (AMR). As such, decreasing inappropriate use of antimicrobials can reduce AMR. The main objective of this systematic review was to identify the effectiveness of AMS interventions in reducing inappropriate antimicrobial use in residential aged care facilities (RACFs).
 Methods: Multiple databases were searched to identify studies evaluating the effectiveness of AMS interventions in RACFs. Descriptive studies and those, which did not report an outcome measure related to antibiotic usage, were excluded.
 Results: Overall, 6505 studies were identified and 17 were included. Most of the studies were randomized controlled trials and single faceted interventions. All of the interventions were education and training targeted at physicians, nurses or both about appropriate use of antimicrobials in RACFs. The studies reported a high success rate with 68% of interventions being successful while 32% of interventions were found to be ineffective.
 Conclusion: Educating and training nurses and physicians about evidence-based management of infectious diseases may lead to a reduction in inappropriate antimicrobial use in RACFs. The likelihood of success increases with targeting physicians - either as the sole recipient of the intervention or together- with nurses.
Highlights
The World Health Organization (WHO) declared antimicrobial resistance (AMR) as one of the threats to human health with an estimated mortality amounting to 10 million deaths annually by 2050 1,2
Most studies were conducted in North America with 8 in the United States of America (USA) 42,45,47,50–52, 1 in Canada 57, and 1 as a multicenter study in the USA and Canada 44
Since there was a paucity of information regarding the successful interventions to improve antimicrobial use in residential aged care facilities (RACFs), this systematic review was conducted to provide an overview of different infection-related interventions in RACFs all over the world
Summary
The World Health Organization (WHO) declared antimicrobial resistance (AMR) as one of the threats to human health with an estimated mortality amounting to 10 million deaths annually by 2050 1,2. Inappropriate use of antimicrobials is one of the leading causes of increasing antimicrobial resistance (AMR). The main objective of this systematic review was to identify the effectiveness of AMS interventions in reducing inappropriate antimicrobial use in residential aged care facilities (RACFs). All of the interventions were education and training targeted at physicians, nurses or both about appropriate use of antimicrobials in RACFs. The studies reported a high success rate with 68% of interventions being successful while 32% of interventions were found to be ineffective. Conclusion: Educating and training nurses and physicians about evidence-based management of infectious diseases may lead to a reduction in inappropriate antimicrobial use in RACFs. The likelihood of success increases with targeting physicians - either as the sole recipient of the intervention or together- with nurses.
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