Trends in Antimicrobial Stewardship in Diagnostic Laboratories for Long-Term Care Facilities

Antimicrobial Stewardship: A Major Role for Laboratories in Long-Term Care

Alarming rates of antibiotic resistance have led US state and local health departments to place increased pressure on healthcare providers to improve antibiotic prescription practices. A trend of intensified focus on antibiotic stewardship programs (ASP) is placing increasing demands on diagnostic laboratories to support the cause, particularly for those serving long-term care facilities (LTCFs), nursing homes, outpatient clinics, and skilled nursing facilities. For labs, this presents both a challenge and an opportunity.

This post presents the trends shaping ASP in these settings and explores innovative solutions that diagnostic labs can leverage to capitalize on this momentum.

The Push for AMS in Long-Term Care Facilities and Skilled Nursing Settings

Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year.
Core Elements of Antibiotic Stewardship for Nursing Homes

Regulatory Landscape

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have escalated efforts to enforce antimicrobial stewardship practices. LTCFs, in particular, are under increased scrutiny, with CMS imposing penalties for non-compliance with ASP requirements.

The CDC highlights the critical role of ASP in combating the overuse of antibiotics, a problem that plagues 40–75% of prescriptions in nursing homes. By addressing these challenges, ASPs not only protect patients but also reduce the risk of antibiotic resistance, which experts predict will soon rival the impact of major public health crises like COVID-19.

The Consequences of Inaction

Failure to implement effective ASP measures has wide-ranging implications:

• Increased fines and penalties from CMS.
• Higher costs from avoidable infections like Clostridium difficile (C. diff) outbreaks.
• Diminished Medicare and Medicaid reimbursements.
• Reputational damage from declining facility star ratings and poor patient outcomes (e.g.increased adverse reactions and hospital readmissions)

For LTCFs, meeting ASP requirements isn’t just about compliance—it’s about securing their financial and operational stability.

Key Trends in Diagnostic Laboratories Serving Skilled Nursing Facilities

1. Adopting Advanced Diagnostic Technologies

The long-term care sector is increasingly embracing molecular diagnostics, such as PCR testing combined with traditional microbiology. This approach enables precise identification of pathogens, empowering facilities to make informed, evidence-based decisions about antimicrobial use.

Diagnostic labs have an opportunity to position themselves as essential partners by providing tools that align with these advancements.

2. Integrated ASP Tools for Better Outcomes

Labs equipped with comprehensive ASP tools are invaluable to LTCFs. Arkstone’s advanced OneChoice® report is a prime example. It combines patient-specific data, such as organisms and resistance genes detected, patient allergies and diagnosis, and more, with treatment recommendations that provide pinpointed and targeted guidance based on the standard of care. This helps clinicians make informed decisions, ensuring compliance with ASP requirements while improving patient care. In addition, with Arkstone’s Fusion report, cultures and molecular data from a single sample or multiple samples are consolidated into one comprehensive recommendation, empowering healthcare providers to make accurate, well-informed decisions using different modalities of diagnostics simultaneously. 

Additional capabilities, like monthly tracking and reporting tools for co-op meetings, give facilities a clear view of their antimicrobial usage and outcomes, aligning with CDC’s emphasis on tracking and reporting.

3. Comprehensive ASP Programs

The CDC identifies seven core elements of effective ASPs: leadership, accountability, drug expertise, action, tracking, reporting, and education. Diagnostic labs that offer ASP programs incorporating these elements can serve as critical enablers for LTCFs striving to meet these standards.

“Antimicrobial stewardship often begins at the diagnostic level, where accurate and prompt detection of infections is critical for effective treatment. This underscores the growing importance of implementing stewardship practices seamlessly with the laboratory.” 

Dr. Ari Frenkel, MD MPH. Chief Science Officer
Arkstone Medical Solutions

Effective antimicrobial stewardship programs (ASPs) bring substantial clinical and financial benefits to long-term care facilities. 

• Reduce antibiotic overuse 
• Decrease adverse drug reactions
• Improve patient outcomes and lowers readmission rates 
• Reduce CMS flags and comply with regulatory standards measures 

Labs Deliver More Value with Integrated Advanced Reporting Solutions and Modern Lab Systems

Dendi Laboratory Information System Integration

Dendi’s laboratory information system (LIS) provides a modern, cloud-native platform designed to elevate laboratory operations. With advanced interoperability capabilities and rapid implementation, Dendi LIS’ advanced API ensures that labs can easily integrate with essential antimicrobial stewardship tools like Arkstone’s OneChoice® report.

Arkstone’s Antimicrobial Stewardship Solutions

Arkstone’s comprehensive ASP programs enable labs to provide LTCFs with:

• Infectious disease guidance via the OneChoice® report
• Infection control guidelines to prevent disease spread and reduce outbreaks.
• Monthly reviews and data tracking to align with regulatory reporting requirements as well as critical information for QAPI meetings

Together, Dendi and Arkstone offer labs a turnkey solution to deliver actionable ASP insights, reduce operational friction, and ensure compliance with stringent healthcare regulations.

Chief Science Officer and infectious disease specialist, Dr. Frenkel notes that “antimicrobial stewardship often begins at the diagnostic level, where accurate and prompt detection of infections is critical for effective treatment. This underscores the growing importance of implementing stewardship practices as a collaboration with the laboratory, so that effective antimicrobial stewardship occurs the moment the infection is diagnosed, and the clinician receives their results.”

An Opportunity for Diagnostic Labs

For labs, ASP isn’t just a compliance-driven necessity—it’s a competitive differentiator. Labs with integrated ASP capabilities can offer LTCFs a clear value proposition: compliance, cost savings, and better patient outcomes.

By aligning with ASP trends, labs can build stronger relationships with healthcare providers in skilled nursing facilities, opening doors to new business opportunities and long-term growth.

Take Action Against Antibiotic Resistance Today

Antimicrobial stewardship is no longer optional for healthcare providers within the SNF setting, and diagnostic labs are uniquely positioned to support this mission. By integrating Dendi LIS with Arkstone’s OneChoice® report, labs can offer LTCFs the tools they need to succeed in a compliance-driven market.

Ready to transform your lab into a strategic partner for long-term care providers? Contact us today to learn more about how our integrated solutions can help your lab stay ahead in the evolving healthcare landscape.

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