Antimicrobial stewardship (AMS) in residential aged care facilities

• 
  Project Lead
  Associate Professor Rhonda Stuart

  rhonda.stuart@monashhealth.org

  +61 3 9594 2987

Project Details

Antimicrobial resistance is recognised to be a global threat to human health, with the World Health Organization (WHO) listing it as a priority issue of our time. Of concerned is emerging evidence suggesting that residential aged care facilities (RACFs) may be acting as a ‘reservoir and gateway’ for multi-drug resistant (MDR) organism transmission (into hospitals and other parts of the general community). 

Thus, there is an urgent need to optimise the use of antimicrobials in the RACF setting given that, inappropriate use of antimicrobials increases selection pressure for MDR organisms. 

Accordingly, this project is geared towards optimising antimicrobial use in the RACFs setting by addressing the following:

• What is the best way to measure antibiotic consumption in aged care facilities and to obtain antibiotic susceptibilities of the organisms cultured?
• Can the National Antimicrobial Prescribing Survey be applied to aged care facilities? Is it feasible and are the results meaningful?
• What intervention to improve antimicrobial prescribing in aged care facilities is feasible, appropriate and acceptable to stakeholders?
• Can this intervention improve outcomes (reduce antibiotic use, more appropriate prescribing, reduce resistant pathogens, improve satisfaction of staff/ residents/carers)?

Researchers

• A/Professor Rhonda Stuart CI
• A/Professor Caroline Marshall CI
• Professor Mike Richards CI
• Dr David Kong CI
• Dr N.Deborah Friedman AI
• Dr Noleen Bennett

Funding

• NHMRC CRE Grant APP1079625

Research Publications

1. Lim CJ, Stuart RL, Kong DC. Antibiotic use in residential  aged care facilities. Aust Fam Physician. 2015 Apr;44(4):192-6. Review. PubMed PMID:25901402.
2. Lim CJ, Kwong MW, Kong DC. Antibiotic prescribing practice in residential aged care facilities--health care providers' perspectives. Med J Aust. 2015 Mar 2;202(4):180. PubMed PMID: 25716595.
3. Lim CJ, Kwong M, Stuart RL, Buising KL, Friedman ND, Bennett N, Cheng AC,Peleg AY, Marshall C, Kong DC. Antimicrobial stewardship in residential aged care facilities: need and readiness assessment. BMC Infect Dis. 2014 Jul 23;14:410.doi: 10.1186/1471-2334-14-410. PubMed PMID: 25055957; PubMed Central PMCID:
   PMC4117949.
4. Lim CJ, Kwong MW, Stuart RL, Buising KL, Friedman ND, Bennett NJ, Cheng AC,Peleg AY, Marshall C, Kong DC. Antibiotic prescribing practice in residential aged care facilities--health care providers' perspectives. Med J Aust. 2014 Jul 21;201(2):98-102. Erratum in: Med J Aust. 2014 Nov 17;201(10):574. Peleg, Anton [corrected to Peleg, Anton Y]. PubMed PMID: 25045989.
5. Lim CJ, Cheng AC, Kennon J, Spelman D, Hale D, Melican G, Sidjabat HE, Paterson DL, Kong DC, Peleg AY. Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: a nested case-control study. J Antimicrob Chemother. 2014 Jul;69(7):1972-80. doi: 10.1093/jac/dku077. Epub 2014 Apr 7. PubMed PMID: 24710025.
6. Lim CJ, Cheng AC, Kong DC, Peleg AY. Community-onset bloodstream infection with multidrug-resistant organisms: a matched case-control study. BMC Infect Dis. 2014 Mar 4;14:126. doi: 10.1186/1471-2334-14-126. PubMed PMID: 24592979; PubMed Central PMCID: PMC3975842.
7. Lim CJ, Kong DC, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging. 2014 Jan 13;9:165-77. doi: 10.2147/CIA.S46058. eCollection 2014. Review. PubMed PMID: 24477218; PubMed Central PMCID: PMC3894957.
8. Lim J Ching, Kwong M, Stuart RL, Buising KL, Friedman ND, Bennett N, Cheng AC, Peleg AY, Marshall C, Kong DCM Antimicrobial Stewardship in Residential Aged Care Facilities: Need and Readiness Assessment.  BMC Infectious Diseases 2014, 14:410  DOI: 10.1186/1471-2334-14-410
9. Kong DCM, Lim CJ, Stuart RL, Buising KL, Friedman D, Bennett N, Worth L, Thursky K, Cheng A, Peleg AY, Marshall C. Case for Action proposal: Antimicrobial usage in residential aged-care facilities. Submitted by the NHMRC Research Translation Faculty New and Emerging Health Threats Steering Group; NHMRC, 2015. http://www.nhmrc.gov.au/research/research-translation/research-translation-faculty/ideas-research-translation-faculty-cases
10. Stuart RL, Marshall C, Orr L, et al. A Survey of Infection Control and Antimicrobial Stewardship Practices in Australian Residential Aged Care Facilities. Int Med Journal 2015 published online May 2015 doi:10.1111/imj.12740
11. Stuart RL, Orr E, Kotsanas D, Gillespie EE. A Nurse Led Antimicrobial Stewardship Intervention in Two Residential Aged Care Facilities. Healthcare Infection. 2015 20 4-6
12. Stuart RL, Wilson J, Bellaard-Smith E, et al. Antibiotic use and misuse in residential aged care facilities. Int Med J. 2012; 42, (10), 1145-49
13. Stuart RL, Kotsanas D, Gillespie EE et al. High prevalence of multiresistant E coli in residential aged care facilities. Med JAustralia 2011: 195: 530-533