2nd ASAP Symposium, Presentation #4 is out now
Each session from the 2025 ASAP Symposium in Bern looked at a different area where antimicrobial stewardship in Swiss outpatient care needs to improve. The first half of the programme focused on clinical guidelines (see our previous posts). The second half turned to a setting that sits at the edges of both inpatient and outpatient care: long-term care facilities.
Long-term care facilities occupy an unusual position in the Swiss healthcare landscape. Residents live there permanently; care is delivered by nursing staff with doctors visiting intermittently; prescribing decisions are often made without seeing the patient. Infection prevention and stewardship structures do not transfer automatically to this setting, yet antimicrobial use is substantial and, until recently, was largely unmeasured.
Domenica Flury presented the results of SPOT, Switzerland's first national point prevalence survey of healthcare-associated infections and antimicrobial use in long-term care facilities. 94 institutions, 7,244 residents.
Antibiotic use rates are broadly in line with EU averages, but variation between institutions and across language regions is wide. The data now exist to start asking why.
Outside of flu season, urinary tract infections are the most common infection, and urinary catheters are a potentially modifiable risk factor.
One in three antimicrobial prescriptions is for prophylaxis. That proportion warrants closer examination.
Stewardship structures are largely absent. Many facilities regard antimicrobial use as a matter for the prescribing GP, not the institution. That division of responsibility leaves a gap that neither side is filling.