***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Asymptomatic bacteriuria in the elderly commonly results in antibiotic administration and , in turn , contributes to antimicrobial resistance , adverse drug events , and increased costs . This is a major problem in the long-term care facility ( LTCF ) setting , where residents frequently transition to and from the acute-care setting , often transporting drug-resistant organisms across the continuum of care . The goal of this study was to assess the feasibility and efficacy of antimicrobial stewardship programs ( ASPs ) targeting urinary tract infections ( UTIs ) at community LTCFs . Methods This was a quasi-experimental study targeting antibiotic prescriptions for UTI using time-series analysis with 6-month retrospective pre-intervention and 6-month intervention period at three community LTCFs . The ASP team ( infectious diseases ( ID ) pharmacist and ID physician ) performed weekly prospect i ve audit and feedback of consecutive prescriptions for UTI . Loeb clinical consensus criteria were used to assess appropriateness of antibiotics ; recommendations were communicated to the primary treating provider by the ID pharmacist . Resident outcomes were recorded at subsequent visits . Generalized estimating equations using segmented regression were used to evaluate the impact of the ASP intervention on rates of antibiotic prescribing and antibiotic resistance . Results One-hundred and four antibiotic prescriptions for UTI were evaluated during the intervention , and recommendations were made for change in therapy in 40 ( 38 % ) , out of which 10 ( 25 % ) were implemented . Only eight ( 8 % ) residents started on antibiotics for UTI met clinical criteria for antibiotic initiation . An immediate 26 % decrease in antibiotic prescriptions for UTI during the ASP was identified with a 6 % reduction continuing through the intervention period ( 95 % Confidence Interval ( [ CI ) ] for the difference : −8 to −3 % ) . Similarly , a 25 % immediate decrease in all antibiotic prescriptions was noted after introduction of the ASP with a 5 % reduction continuing throughout the intervention period ( 95 % CI : −8 to −2 % ) . No significant effect was noted on resistant organisms or Clostridium difficile . Conclusion Weekly prospect i ve audit and feedback ASP in three community LTCFs over 6 months result ed in antibiotic utilization decreases but many lost opportunities for intervention OBJECTIVES To evaluate the use of diagnostic testing before treating an infection in nursing home ( NH ) residents suspected of having a urinary tract infection ( UTI ) or pneumonia . DESIGN Prospect i ve longitudinal study nested within a r and omized trial , using data from control sites . SETTING Six NHs in southeast Michigan . PARTICIPANTS NH residents with an indwelling urinary catheter , enteral feeding tube , or both ( N = 162 ) with 695 follow-up visits ( 189 ( 28 % ) visits with an infection ) . MEASUREMENTS Clinical and demographic data -including information on incident infections , antibiotic use , and results of diagnostic tests-were  obtained at study enrollment , after 14 days , and monthly thereafter for up to 1 year . RESULTS One hundred ( 62 % ) NH residents had an incident infection requiring antibiotics , with substantial variations between NHs . In addition to presence of infection-specific symptoms , change in function was a significant predictor of ordering a chest X-ray to detect pneumonia ( odds ratio ( OR ) = 1.7 , P = .01 ) . Similarly , change in mentation was a significant predictor of ordering a urinalysis ( OR = 1.9 , P = .02 ) , chest X-ray ( OR = 3.3 , P < .001 ) , and blood culture ( OR = 2.3 , P = .02 ) . Antibiotics were used empirically , before laboratory results were available , in 50 of 233 suspected cases of UTI ( 21.5 % ) and 16 of 53 ( 30.2 % ) suspected cases of pneumonia .  Antibiotics  were used in 17 % of visits without documented clinical or laboratory evidence of infection . CONCLUSION Constitutional symptoms such as change in function and mentation commonly lead to diagnostic testing and subsequent antibiotic prescribing . Antibiotic use often continues despite negative test results and should be a target for future interventions OBJECTIVES To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents . DESIGN Prospect i ve , observational study . SETTING Academic nursing home located in an urban setting . PARTICIPANTS Two hundred two newly admitted residents . MEASUREMENTS Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record . Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review . Follow-up was divided into 10-day intervals , and concordance between nonspecific symptoms and acute illness within these intervals was determined . Predictive values were calculated according to st and ard formulae . RESULTS Nonspecific symptoms and acute illnesses occurred in 21.7 % and 12.5 % of 10-day intervals , respectively . Positive predictive values ( PPVs ) were highest for lethargy , weakness , and decreased appetite , each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported . Agitation and disorientation predicted an acute illness one out of three times , and falls predicted an acute illness one out of four times . Overall , the PPV of the occurrence of any nonspecific symptom was 0.24 , and the negative predictive value of the absence of nonspecific symptoms was 0.91 . CONCLUSION Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness . Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness OBJECTIVES To evaluate the impact of ' Resident Antimicrobial Management Plan ' ( RAMP ) , a novel antimicrobial stewardship tool on systemic antibiotic use for treatment of infection in nursing homes ( NHs ) . METHODS A pilot cluster r and omized control study was conducted in 30 NHs in London . Pre-intervention , we collected point prevalence data on antimicrobial use on three occasions and total antimicrobial consumption for a 12 week period . Post-intervention data were collected in the same manner and included assessment of compliance with RAMP in the intervention group ( IG ) . RESULTS The number of residents included was 1628 pre-intervention [ 825 IG/803 control group ( CG ) ] and 1610 post-intervention ( 838 IG/772 CG ) . The corresponding pre- and post-intervention point prevalence of systemic antibiotic prescribing for treatment of infection was 6.46 % and 6.52 % in the IG [ estimated prevalence ratio : 1.01 ( 95 % CI : 0.81 - 1.25 ) , P = 0.94 ] compared with 5.27 % and 5.83 % , respectively , in the CG [ estimated prevalence ratio : 1.11 ( 95 % CI : 0.87 - 1.41 ) , P = 0.4 ] . Total antibiotic consumption was 69.78 defined daily doses/1000 residents/day ( DRD ) pre-intervention and 66.53 DRD post-intervention in the IG compared with 49.68 and 51.92 DRD , respectively , in the CG . There was a significant decrease of 4.9 % ( 3.25 DRD ) in the IG ( 95 % CI : 1.0%-8.6 % ) ( P = 0.02 ) compared with a significant increase of 5.1 % ( 2.24 DRD ) in the CG ( 95 % CI : 0.2%-10.2 % ) ( P = 0.04 ) . Main indications for antibiotics were lower respiratory tract infections ( 34.1 % ) , urinary tract infections ( 28.5 % ) and skin/soft tissue infections ( 25.1 % ) . CONCLUSIONS This pilot study demonstrated that use of RAMP was associated with a statistically significant decrease in total antibiotic consumption and has the potential to be an important antimicrobial stewardship tool for NHs OBJECTIVES To assess the feasibility of a multifaceted strategy to translate evidence -based guidelines for treating nursing home-acquired pneumonia ( NHAP ) into practice using a small intervention trial . DESIGN Pre-posttest with untreated control group . SETTING Two Colorado State Veterans Homes ( SVHs ) during two influenza seasons . PARTICIPANTS Eighty-six residents with two or more signs of lower respiratory tract infection . INTERVENTION Multifaceted , including a formative phase to modify the intervention , institutional-level change emphasizing immunization , and availability of appropriate antibiotics ; interactive educational sessions for nurses ; and academic detailing . MEASUREMENTS Subjects ' SVH medical records were review ed for guideline compliance retrospectively for the influenza season before the intervention and prospect ively during the intervention . Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test . RESULTS At the intervention facility , compliance with five of the guidelines improved : influenza vaccination , timely physician response to illness onset , x-ray for patients not being hospitalized , use of appropriate antibiotics , and timely antibiotic initiation for unstable patients . Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year . CONCLUSION Multifaceted , evidence -based , NHAP guideline implementation improved care processes in a SVH . Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents ABSTRACT The epidemiology of new acquisition of antibiotic-resistant organisms ( AROs ) in community-based skilled nursing facilities ( SNFs ) is not well studied . To define the incidence , persistence of , and time to new colonization with methicillin-resistant Staphylococcus aureus ( MRSA ) , vancomycin-resistant enterococci ( VRE ) , and ceftazidime-resistant ( CAZr ) and ciprofloxacin-resistant ( CIPr ) Gram-negative bacteria ( GNB ) in SNFs , SNF residents were enrolled and specimens from the nares , oropharynx , groin , perianal area , and wounds were prospect ively cultured monthly . St and ard microbiological tests were used to identify MRSA , VRE , and CAZr and CIPr GNB . Residents with at least 3 months of follow-up were included in the analysis . Colonized residents were categorized as having either preexisting or new acquisition . The time to colonization for new acquisition of AROs was calculated . Eighty-two residents met the eligibility criteria .  New acquisition of AROs was common . For example , of the 59 residents colonized with CIPr GNB , 28 ( 47 % ) were colonized with CIPr GNB at the start of the study ( 96 % persistent and 4 % intermittent ) , and 31 ( 53 % ) acquired CIPr GNB at the facility ( 61 % persistent ) . The time to new acquisition was shortest for CIPr GNB , at a mean of 75.5 days ; the time to new acquisition for MRSA was 126.6 days ( P = 0.007 versus CIPr GNB ) , that for CAZr was 176.0 days ( P = 0.0001 versus CIPr GNB ) , and that for VRE was 186.0 days ( P = 0.0004 versus CIPr GNB ) . Functional status was significantly associated with new acquisition of AROs ( odds ratio [ OR ] , 1.24 ; P = 0.01 ) . New acquisition of AROs , in particular CIPr GNB and MRSA , is common in SNFs . CIPr GNB are acquired rapidly . Additional longitudinal studies to investigate risk factors for ARO acquisition are required OBJECTIVES To use a simple measure of activities of daily living , wounds , and indwelling devices ( urinary catheter , feeding tube ) to predict prevalent , new , and intermittent multidrug-resistant organism ( MDRO ) acquisition in nursing home ( NH ) residents . DESIGN Secondary analysis , prospect i ve cohort study . SETTING Southeast Michigan NHs ( n = 15 ) . PARTICIPANTS NH residents ( N = 111 , mean age 81 ) with two or more monthly visits ( 729 total ) . MEASUREMENTS Monthly microbiological surveillance for MDROs  from multiple anatomic sites from enrollment until discharge or 1 year . The Arling scale , previously developed as a measure of NH residents ' need ( time-intensity ) for nursing re sources , was used to predict prevalent and time to new or intermittent acquisition ( months ) of methicillin-resistant Staphylococcus aureus ( MRSA ) , vancomycin-resistant enterococci ( VRE ) , and antibiotic-resistant gram-negative bacteria ( R-GNB ) colonization using multiple-failure accelerated time-factor survival analysis , controlling for comorbidity , hospitalization , and antibiotic use in the prior month . RESULTS One-fifth of participants had 
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DISCUSSION The limited research to date suggests that NH ASPs can affect intermediate health outcomes , but not key health outcomes or health care utilization .