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Infect Dis Clin North Am. 2020 Mar;34(1):129-143. doi: 10.1016/j.idc.2019.10.007.

Recommendations for Improving Antimicrobial Stewardship in Long-Term Care Settings Through Collaboration.

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Tennessee Department of Health, Andrew Johnson Tower, 3.417C, 710 James Robertson Parkway, Nashville, TN 37243, USA. Electronic address:
Geriatric Research Education and Clinical Center (GRECC); Specialty Care Center of Innovation at the VA Northeast Ohio Healthcare System, Cleveland, OH, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
Duke Center for Antimicrobial Stewardship and Infection Prevention, Division of Infectious Diseases, Duke University School of Medicine, DUMC PO Box 102359, Durham, NC 27710, USA.


Antimicrobial stewardship is a collaborative venture and antimicrobial stewardship in long-term care (LTC) settings is no exception. There are many barriers to implementing effective antimicrobial stewardship programs in LTC settings, including constrained financial resources, limited access to physicians and pharmacists with antimicrobial stewardship training, minimal on-site infectious syndrome diagnostics and laboratory expertise, and high rates of staff turnover. This article suggests that collaboration at the level of health care facilities and systems, with public health departments, with laboratory partners, and among personnel, including nursing staff, prescribers, and pharmacists, can lead to effective antimicrobial stewardship programs in LTC settings.


Antibiotic resistance; Antimicrobial stewardship; Clostridioides difficile; Collaboration; Long-term care facilities


Conflict of interest statement

Conflicts of Interest None of the authors have relevant conflicts of interest to disclose. R.L.P. Jump has received research funding from the Steris Corporation, Accelerate Diagnostics and Pfizer; she has also participated in advisory boards for Pfizer and Merck.

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