Antimicrobial stewardship in long term care facilities - evidence based interventions, implementation tools, and impact metrics

Sep 29, 2026

Uploaded by Elsa

Centers for Medicare and Medicaid Services mandated Antimicrobial Stewardship Programs for U.S. skilled nursing facilities, yet high reported compliance can conceal persistent shortcomings in clinical effectiveness. This review synthesizes evidence-based antimicrobial stewardship interventions, summarizes their impact, and outlines practical implementation tools and resource-variable metrics. Guidance draws on CDC and AHRQ resources, other established frameworks, and proposed measures to support effective stewardship across long-term care settings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Evidence on ASP interventions in LTCFs

Target syndromes and common intervention themes

Table 1: systematic literature reviews and meta-analyses

Antimicrobial Stewardship & Healthcare Epidemiology (2026), 6, e6, 1–5 doi:10.1017/ash.2025.10255 Review Antimicrobial stewardship in long term care facilities: evidence based interventions, implementation tools, and impact metrics Tristan T. Timbrook PharmD, MPH1,2 , Chelsea Campbell PharmD, MSPH3 and Pamela Bailey DO, MPH4,5 1Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, MO, USA, 2Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA, 3South Carolina Department of Public Heath, Columbia, SC, USA, 4Department of Internal Medicine, Prisma Health Midlands, Division of Infectious Diseases, Columbia, SC, USA and 5University of South Carolina School of Medicine, Columbia, SC, USA Abstract While Centers for Medicare and Medicaid Services-mandated Antimicrobial Stewardship Programs are now in place across U.S. skilled nursing facilities, reported high rates of compliance may mask persistent gaps in clinical effectiveness. This review summarizes evidence-based antimicrobial stewardship interventions, their impact, and practical tools to support implementation. Resources from Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, other frameworks, and proposed metrics are highlighted to guide effective stewardship in resource-variable nursing home settings. (Received 19 May 2025; accepted 3 December 2025) Introduction Even though U.S. regulations under 42 CFR §483.80 Centers for Medicare and Medicaid Services (CMS) mandate structured Antimicrobial Stewardship Programs (ASPs) in skilled nursing facilities (SNFs), meeting regulatory minimums does not guarantee clinically effective stewardship.1 SNFs continue to exhibit substantial gaps in prescribing quality with approximately 1 out of every 10 residents are actively receiving an antibiotic and around 50% of prescriptions deemed inappropriate in indication, dose, or duration.2,3 Inappropriate antibiotic practices directly contribute to elevated rates of antimicrobial resistance, Clostridioides difficile infection increases, and worse patient outcomes.4,5 Following the 2016 CMS regulation self-reported progress has been substantial with adherence to stewardship best practices rising from 42% to 83% among facilities participating in the National Healthcare Safety Network (NHSN) .6,7 Yet important gaps remain. A state-based survey beyond just NHSN facilities indicated only 67% of facilities report access to infectious diseases expertise, suggesting NHSN-reporting facilities may not be representative.8 Moreover, even among NHSN-reporting facilities less than one-third use electronic health records for antibiotic use tracking.7 These are not minor oversights as prospective audit with feedback from infectious diseases experts is a core driver of ASP success, and accurate tracking is essential for measuring impact.9 Consequently, program effectiveness varies widely despite CMS requirements. Corresponding author: Tristan T. Timbrook; Email: [tristan.timbrook@bjc.org](tristan.timbrook@bjc.org) [Cite this article:](Cite this article: Timbrook TT)[ Timbrook TT](Cite this article: Timbrook TT), [Campbell C](Campbell C), [Bailey P](Bailey P). Antimicrobial stewardship in long term care facilities: evidence based interventions, implementation tools, and impact metrics. Antimicrob Steward Healthc Epidemiol 2026. doi: 10.1017/ash.2025.10255 While CMS regulations specifically target SNFs, the evidence base for effective antimicrobial stewardship spans the broader landscape of long-term care. Accordingly, this review synthesizes these evidence-based interventions for application across all longterm care facilities (LTCFs), grounding them in the specific CMS requirements for SNFs and highlighting practical, LTCF-specific tools for implementation and measurement.10 Evidence on ASP interventions in LTCFs The literature on antimicrobial stewardship in long-term care has expanded dramatically

FAQs

Why can regulatory compliance under CMS antimicrobial stewardship requirements still fail to achieve clinical effectiveness?

Meeting regulatory minimums does not guarantee clinically effective stewardship. Facilities still show gaps in prescribing quality, including inappropriate antibiotic use by indication, dose, or duration.

What kinds of antimicrobial stewardship interventions are commonly emphasized in long-term care facilities?

Interventions frequently target specific syndromes such as urinary tract infections and respiratory infections. They also differentiate asymptomatic bacteriuria from active infection, optimize agent selection, and reduce duration, often using multimodal approaches.

How do the authors suggest measuring antimicrobial stewardship impact in long-term care?

Accurate tracking is essential for measuring impact, and the review highlights proposed metrics and implementation tools to guide effective stewardship in resource-variable nursing home settings.

Sep 29, 2026

Uploaded by Elsa