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Title page

Contents

Acknowledgements 4

Abstract 5

Résumé 6

Acronyms and Concepts 10

1. Introduction 11

1.1. Scope and overview 11

2. Antimicrobial resistance in long-term care facilities is a unique threat 15

2.1. Long-term care residents are at higher risk of health care associated infections compared to older people living in the community 15

2.2. Infection prevention and control is more challenging in long-term care facilities than in acute care hospitals 16

2.3. Multi-drug resistant organisms are more prevalent and severe in long-term care facilities than in the community 17

3. Trends in antimicrobial use and resistance in long-term care 18

3.1. Empirical prescribing and extended prophylaxis are common in long-term care facilities 19

3.2. A significant share of antimicrobial prescriptions in long-term care facilities are inappropriate 20

3.3. Inappropriate antimicrobial consumption in long-term care facilities puts all residents at risk, not just those taking antimicrobials 22

3.4. Factors behind inappropriate use of antimicrobials in long-term care facilities relate to residents and their relatives, prescribers, facilities, health care... 23

3.5. Resistant organisms are becoming more prevalent in long-term care facilities 24

3.6. There is resistance in long-term care facilities to critically important antimicrobials 25

4. Interventions to tackle antimicrobial resistance in long-term care 27

4.1. Better surveillance of antimicrobial resistance and more testing in long-term care settings are needed 27

4.2. Antimicrobial stewardship programmes can prevent antimicrobial resistance in long-term care facilities 29

4.3. Infection prevention and control should be implemented alongside antimicrobial stewardship programmes 35

5. Conclusion 42

References 44

Annex A. Data Sources 59

Annex B. Literature sources reporting on inappropriate use of antimicrobials in long-term care facilities 60

Annex C. Choosing Wisely minimum criteria for urinary tract infections 62

OECD Health Working Papers 63

Tables

Table 4.1. Structure and process indicators of antimicrobial stewardship programmes reported in participating long-term care facilities, by country 30

Table 4.2. Choosing Wisely® practice change recommendations to reduce unnecessary antimicrobial use for asymptomatic bacteriuria in long-term care... 33

Figures

Figure 1.1. Wide variation in the average age of long-term care facility residents surveyed in point prevalence surveys in EU/EEA and Australia 13

Figure 2.1. Results of point prevalence surveys of health care associated infections among long-term care facility residents in participating OECD countries,... 16

Figure 3.1. Use of antimicrobials in long-term care facilities in OECD and EU/EEA countries 18

Figure 3.2. Indication for antimicrobial use among long-term care facility residents in EU/EEA countries, 2016-17 20

Figure 3.3. A significant share of antimicrobial prescriptions are considered inappropriate 21

Figure 3.4. ECDC Composite Index of AMR in bacteria from health care associated infections among long-term care facilities residents in participating OECD... 25

Figure 4.1. EVIPNet Europe's three viable options to promote optimal antimicrobial use in long-term care facilities 28

Figure 4.2. Best practice recommendations for infection prevention and control in long-term care facilities 36

Figure 4.3. Costs of controlling a drug-resistant K. pneumoniae outbreak in The Netherlands 41

Boxes

Box 1.1. Gaps in data availability restrict focus to long-term care facility residents 12

Box 1.2. The impact of COVID-19 on antimicrobial resistance in long-term care facilities 14

Box 3.1. The ECDC Composite Index of AMR in isolates recovered from health care associated infections 25

Box 4.1. United States CDC core elements of antibiotic stewardship in long-term care facilities 32

Box 4.2. A community wide programme for the wise use of antimicrobials in Canadian long-term care facilities 35

Box 4.3. A national implementation project to prevent catheter-associated urinary tract infections in long-term care facility residents 38

Box 4.4. The business case for infection prevention and control in a long-term care facility 41

Annex Tables

Table A.1. Data sources used in this report 59

Table B.1. Literature on inappropriate use of antimicrobials in long-term care facilities, by criteria 60

Table C.1. Choosing Wisely minimum criteria for urinary tract infections 62

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