The forgotten facility: Australia’s lax response to controlling antibiotic resistance in nursing homes

Abstract

Antibiotic resistance poses a significant threat to public health globally. Awareness and measures to address antibiotic resistance in the acute hospital setting are evident and successful, yet the same attention to this in Australian nursing homes is lacking. With Australia’s population ageing, a deficit such as this is clearly worrisome. This review examines current strategies that address antibiotic resistance in Australian nursing homes to demonstrate that while infection control strategies are in place in nursing homes, a standardised and comprehensive approach to control antibiotic resistance is absent. One strategy proposed is the implementation of antimicrobial stewardship (AMS) to optimise and regulate the use of antibiotics. In theory, AMS has been proven to be an effective strategy to control antibiotic resistance in nursing homes, however as the determinants of antibiotic resistance in this setting are complex and multifaceted, the practical application of AMS is compromised. Such determinants include a current lack of awareness of AMS by nursing home staff, poor microbiological testing practices, and sociocultural pressures that increase antibiotic prescribing rates and reduce patient compliance to treatment regimes. When combined, these factors have a detrimental effect which acts to increase antibiotic misuse in this setting, strongly correlating with the emergence of antibiotic resistance. This review underscores the lacuna in action focused on overcoming such barriers which clearly hinders our efforts to control antibiotic resistance. Hence, if effective and feasible strategies to address antibiotic resistance are to be developed, further research into the role of the institutional determinants that surround AMS implementation in Australian nursing homes is urgently needed.