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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

CDC urges antibiotic stewardship programs in nursing homes

Antibiotic stewardship is one of the important infection prevention strategies emphasized on the Centers for Disease Control and Prevention‘s new website on long term care, where up to 70% of residents receive an antibiotic every year.

The CDC is trying to raise awareness about the need for stewardship programs to curtail the overuse and misuse of antibiotics in nursing homes by reminding administrators and clinicians in long term care to consider these key points:

  • Estimates of the cost of antibiotics in the long-term care setting range from $38 million to $137 million per year.
  • Among the antibiotic-resistant organisms most commonly found in nursing home populations are multidrug-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE).
  • Antibiotic resistance in long-term care is associated with increased risk of hospitalization, increased cost for treatment, and increased risk of death.
  • Many long-term care residents may be colonized with bacteria rather than infected. The challenge of separating colonization from true infection can contribute to antibiotic overuse in this setting. For example, studies have consistently shown that about 30%-50% of frail, elderly long-term care residents can have a positive urine culture even without any symptoms of a urinary tract infection. Unfortunately, many of these patients are placed inappropriately on antibiotics.
  • Poor communication when patients transfer facilities, for example from a nursing home to a hospital, can result in antibiotic misuse.
  • Antibiotic-related complications, such as diarrhea from Clostridium difficile infections, can be more severe, difficult to treat, and lead to more hospitalizations and deaths among people over 65 years. Long-term care facility residents are particularly at risk for these complications.