30/11/20

White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in long-term care facilities-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in long-term care facilities-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

J Antimicrob Chemother. 2020 Dec 6;75(Supplement_2):ii33-ii41. doi: 10.1093/jac/dkaa427., 12/2020.

Background: In long-term care facilities (LTCFs)  residents often receive inappropriate antibiotic treatment and infection  prevention and control practices are frequently inadequate, thus  favouring acquisition of MDR organisms. There is increasing evidence in  the literature describing antimicrobial stewardship (AMS) activities in  LTCFs, but practical guidance on how surveillance data should be linked  with AMS activities in this setting is lacking. To bridge this gap, the  JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks joined their efforts to  provide practical guidance for linking surveillance data with AMS  activities.


Materials and methods: Considering  the three main topics [AMS leadership and accountability, antimicrobial  usage (AMU) and AMS, and antimicrobial resistance (AMR) and AMS], a  literature review was performed and a list of target actions was  developed. Consensus on target actions was reached through a  RAND-modified Delphi process involving 40 experts from 18 countries and  different professional backgrounds adopting a One Health approach.


Results: From  the 25 documents identified, 25 target actions were retrieved and  proposed for expert evaluation. The consensus process produced a  practical checklist including 23 target actions, differentiating between  essential and desirable targets according to clinical relevance and  feasibility. Flexible proposals for AMS team composition and leadership  were provided, with a strong emphasis on the need for well-defined and  adequately supported roles and responsibilities. Specific antimicrobial  classes, AMU metrics, pathogens and resistance patterns to be monitored  are addressed. Effective reporting strategies are described.


Conclusions: The  proposed checklist represents a practical tool to support local AMS  teams across a wide range of care delivery organization and availability  of resources.