Evaluating the Effectiveness of Antimicrobial Stewardship Strategies in Residential Aged Care: An Umbrella Review

Objectives To identify, appraise, and synthesize global evidence on the effectiveness of antimicrobial stewardship (AMS) interventions in residential aged care homes (RACHs). Design An umbrella review of systematic reviews and meta-analyses. Setting and Participants Systematic review on AMS interventions for those aged 65 and above who resided in RACHs globally. Fifteen reviews (2013-2024) encompassing 66 unique primary studies were included. Six reviews featured meta-analyses. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches across major databases, including Scopus and PubMed, were conducted. Study selection, data extraction, and quality appraisal were performed independently by 2 reviewers. AMS interventions were mapped against the US Centers for Disease Control and Prevention Core Elements of AMS for nursing homes. Quantitative and qualitative data were synthesized alongside available meta-analyses. Results Multifaceted AMS strategies combining education, clinical guidelines, drug expertise, and audit and feedback were associated with reductions in antimicrobial consumption, infection rates, and urine culture requests. Long-term implementation (up to 60 months) showed decreased antimicrobial resistance among uropathogens. However, interventions demonstrated little to no impact on the appropriateness of antimicrobial selection, hospital admissions, or mortality. Cost-effectiveness data remained limited. Conclusions and Implications Multifaceted AMS interventions are effective in reducing antibiotic use and infection rates in RACHs. Facilities should implement multifaceted strategies, prioritizing education and clinical algorithms. In resource-limited settings, the US Centers for Disease Control and Prevention framework and the World Health Organization AWaRe book can be adaptively scaled using nurse-led champions to circumvent high costs. Future longitudinal studies must use standardized aged-care metrics, evaluate cost-effectiveness, and address global equity by investigating AMS models in low- and middle-income countries.