Antimicrobial Stewardship: Long-Term Care

In recent years an increasing numbers of residents have been admitted to long-term care (LTC) with complicated conditions. Some types of care and treatments that may have been provided in an inpatient setting years ago are now provided in skilled nursing facilities or assisted living facilities. Per the Centers for Disease Control and Prevention, (CDC), antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents receiving one or more antibiotic courses per year. Yet, studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.

While antibiotics can be beneficial for those patients with active bacterial infections, separating out patients who are colonized, but not actively infected with bacteria, remains problematic. Antibiotics may kill the targeted bacteria but also have an effect on other bacteria in the body, this has led to a worldwide problem with antibiotic resistant bacteria. Bacteria resistance can lead to difficulties in treating a residents’ condition and sometimes cause serious, life-threatening illness.

Oversight of antibiotics in LTC facilities, through antibiotic stewardship programs, is essential to help guide the benefits and risks of antibiotic treatments. The Centers for Medicare and Medicaid Service (CMS) has mandated that nursing homes implement antibiotic stewardship programs, which combine data review and prescriber education to reinforce evidence-based practices among clinicians and more effective use of antibiotics.

You can learn more about efforts to promote antibiotic stewardship and prevent healthcare-associated infections (HAIs) in LTC by visiting the HAIs in LTC Coalition webpage.

Two adults standing and smiling.

Many program utilize CDC's Core Elements of Antibiotic Stewardship for Nursing Homes as a roadmap.

These elements include leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.

In Wisconsin, 70% of nursing homes reported adoption of all seven inpatient core elements in 2020.



Antibiotic Allergies

Educational Material


Toolkit to Improve Antibiotic Use in LTC

Wisconsin LTC Urinary Tract Infection Toolkit

Last Revised: January 5, 2022