{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:46:01Z","timestamp":1782726361195,"version":"3.54.5"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Government Medical Research Future Fund","award":["MRF2008752"],"award-info":[{"award-number":["MRF2008752"]}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT119378"],"award-info":[{"award-number":["GNT119378"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2016277"],"award-info":[{"award-number":["GNT2016277"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>While microbiology tests can guide management of infectious diseases, little is known about the prevalence of testing around the time of antibiotic initiation in long-term care facilities (LTCFs). The objectives of this study were to investigate prevalence and factors associated with microbiology testing around the time of antibiotic initiation, and subsequent treatment pathways in LTCFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included individuals aged \u226565\u2005years who entered a LTCF in three Australian states between 1 January 2017 and 30 June 2019, and received a systemic antibiotic (n\u200a=\u200a36\u200a977). Prevalence of microbiology testing in the 14\u2005days pre- and 7\u2005days post-antibiotic initiation, and treatment pathways 14\u2005days post-initiation, were determined. Multivariable logistic regression determined adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs) for factors associated with testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total 15\u200a407 (41.7%) individuals were tested around the time of antibiotic initiation, ranging from 22.9% (n\u200a=\u200a585\/2551 residents) of macrolide initiators to 79.3% (n\u200a=\u200a413\/521) of nitrofurantoin initiators. Individuals with urinary tract infections on LTCF entry (aOR 1.24, 95%CI 1.10\u20131.40) or initiating trimethoprim (aOR 2.80, 95%CI 2.50\u20133.13) were more likely to be tested. Males (aOR 0.81, 95%CI 0.77\u20130.85), and residents who received cephalosporins (aOR 0.75, 95%CI 0.68\u20130.84), penicillins (aOR 0.49, 95%CI 0.45\u20130.55), or with airways disease (aOR 0.87, 95%CI 0.82\u20130.91) had lower odds of testing. Among those tested, 14.5% (n\u200a=\u200a2238) had a second dispensing of the same antibiotic, 11.4% (n\u200a=\u200a1 751) switched antibiotic therapy and 5.9% (n\u200a=\u200a904) were hospitalized within 14\u2005days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With four in ten residents tested, and lower prevalence within certain resident subgroups, this study suggests a high dependence on initiating empiric therapy in LTCFs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag212","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:44:19Z","timestamp":1780659859000},"source":"Crossref","is-referenced-by-count":0,"title":["Microbiology testing around the time of antibiotic initiation among residents of long-term care facilities"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9938-1912","authenticated-orcid":false,"given":"Georgina A","family":"Hughes","sequence":"first","affiliation":[{"name":"School of Allied Health and Human Performance, College of Health, Adelaide University , Adelaide, South Australia ,","place":["Australia"]},{"name":"Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9634-2803","authenticated-orcid":false,"given":"Robert N","family":"Jorissen","sequence":"additional","affiliation":[{"name":"Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]},{"name":"Registry of Senior Australians Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Bedford Park, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2869-7917","authenticated-orcid":false,"given":"Yohanes A","family":"Wondimkun","sequence":"additional","affiliation":[{"name":"School of Allied Health and Human Performance, College of Health, Adelaide University , Adelaide, South Australia ,","place":["Australia"]},{"name":"Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria C","family":"Inacio","sequence":"additional","affiliation":[{"name":"Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]},{"name":"Registry of Senior Australians Research Centre, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Bedford Park, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Lang","sequence":"additional","affiliation":[{"name":"Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noleen","family":"Bennett","sequence":"additional","affiliation":[{"name":"Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne Health , Melbourne, Victoria ,","place":["Australia"]},{"name":"National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon J","family":"Worth","sequence":"additional","affiliation":[{"name":"Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne Health , Melbourne, Victoria ,","place":["Australia"]},{"name":"Sir Peter MacCallum Department of Oncology, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7400-232X","authenticated-orcid":false,"given":"Karin","family":"Thursky","sequence":"additional","affiliation":[{"name":"National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"Sir Peter MacCallum Department of Oncology, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"The Royal Melbourne Hospital Guidance Group, Melbourne Health , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of General Practice, University of Melbourne , Parkville, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"James","sequence":"additional","affiliation":[{"name":"National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne , Parkville, Victoria ,","place":["Australia"]},{"name":"The Royal Melbourne Hospital Guidance Group, Melbourne Health , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9059-5209","authenticated-orcid":false,"given":"Janet K","family":"Sluggett","sequence":"additional","affiliation":[{"name":"School of Allied Health and Human Performance, College of Health, Adelaide University , Adelaide, South Australia ,","place":["Australia"]},{"name":"South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062905094394200_dkag212-B1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjph-2023-000504","article-title":"Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies","volume":"2","author":"Bennett","year":"2024","journal-title":"BMJ Public Health"},{"key":"2026062905094394200_dkag212-B2","doi-asserted-by":"publisher","first-page":"889","DOI":"10.2217\/AHE.11.80","article-title":"Common infections in nursing homes: a review of current issues and challenges","volume":"7","author":"Montoya","year":"2011","journal-title":"Aging Health"},{"key":"2026062905094394200_dkag212-B3","author":"Australian Government Aged Care Quality and Safety Commission 2024"},{"key":"2026062905094394200_dkag212-B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jamda.2019.11.025","article-title":"Progress and challenges in the management of nursing home infections","volume":"21","author":"Sloane","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"2026062905094394200_dkag212-B5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0256501","article-title":"Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985\u20132019: systematic review and meta-analysis","volume":"16","author":"Raban","year":"2021","journal-title":"PLoS ONE"},{"key":"2026062905094394200_dkag212-B6","doi-asserted-by":"publisher","first-page":"189","DOI":"10.5694\/mja2.52709","article-title":"The prevalence of and variation in indicators of the quality and safety of long term aged care in Australia, 2019: a cross-sectional population-based study","volume":"223","author":"Eshetie","year":"2025","journal-title":"Med J Aust"},{"key":"2026062905094394200_dkag212-B7","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1038\/s41467-025-57566-3","article-title":"Epidemiology and transmission dynamics of multidrug-resistant organisms in nursing homes within the United States","volume":"16","author":"Mody","year":"2025","journal-title":"Nat Commun"},{"key":"2026062905094394200_dkag212-B8","author":"Eze","year":"2022"},{"key":"2026062905094394200_dkag212-B9","author":"Oberj\u00e9","year":"2016"},{"key":"2026062905094394200_dkag212-B10","author":"Oberj\u00e9","year":"2016"},{"key":"2026062905094394200_dkag212-B11","author":"European Centre for Disease Prevention and Control 2025"},{"key":"2026062905094394200_dkag212-B12","author":"Royal Melbourne Hospital and the National Centre for Antimicrobial Stewardship 2024"},{"key":"2026062905094394200_dkag212-B13","author":"Australian Commission of Safety and Quality in Health Care (ACSQHC) 2020"},{"key":"2026062905094394200_dkag212-B14","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1046\/j.1532-5415.2001.49999.x","article-title":"Practice guideline for evaluation of fever and infection in long-term care facilities","volume":"49","author":"Bentley","year":"2001","journal-title":"J Am Geriatr Soc"},{"key":"2026062905094394200_dkag212-B15","author":"Australian Commission of Safety and Quality in Health Care (ACSQHC) 2024"},{"key":"2026062905094394200_dkag212-B16","author":"European Centre for Disease Prevention and Control 2013"},{"key":"2026062905094394200_dkag212-B17","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.jamda.2019.07.003","article-title":"Trends in collection of microbiological cultures across veterans affairs community living centers in the United States over 8 years","volume":"21","author":"Appaneal","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"2026062905094394200_dkag212-B18","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1186\/s12879-020-05029-z","article-title":"Microbiology testing associated with antibiotic dispensing in older community-dwelling adults","volume":"20","author":"Peng","year":"2020","journal-title":"BMC Infect Dis"},{"key":"2026062905094394200_dkag212-B19","doi-asserted-by":"publisher","first-page":"2167","DOI":"10.1093\/cid\/ciaa436","article-title":"National trends in antibiotic use in Australian residential aged care facilities, 2005\u20132016","volume":"72","author":"Sluggett","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026062905094394200_dkag212-B20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-066390","article-title":"Registry of Senior Australians (ROSA): integrating cross-sectoral information to evaluate quality and safety of care provided to older people","volume":"12","author":"Inacio","year":"2022","journal-title":"BMJ Open"},{"key":"2026062905094394200_dkag212-B21","author":"Antimicrobial Use and Resistance in Australia (AURA) 2020"},{"key":"2026062905094394200_dkag212-B22","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlab017","article-title":"Comparative analysis of Australian hospital antimicrobial utilization, using the WHO AWaRe classification system and the adapted Australian priority antimicrobial list (PAL)","volume":"3","author":"Hillock","year":"2021","journal-title":"JAC Antimicrob Resist"},{"key":"2026062905094394200_dkag212-B23","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1093\/jac\/dkab007","article-title":"Contribution of facility level factors to variation in antibiotic use in long-term care facilities: a national cohort study","volume":"76","author":"Sluggett","year":"2021","journal-title":"J Antimicrob Chemother"},{"key":"2026062905094394200_dkag212-B24","author":"The University of Adelaide 2016"},{"key":"2026062905094394200_dkag212-B25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-021122","article-title":"The validity of the Rx-Risk Comorbidity Index using medicines mapped to the Anatomical Therapeutic Chemical (ATC) classification system","volume":"8","author":"Pratt","year":"2018","journal-title":"BMJ Open"},{"key":"2026062905094394200_dkag212-B26","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1071\/AH12007","article-title":"Infections and antimicrobial use in Australian residential aged care facilities: a comparison between local and international prevalence and practices","volume":"37","author":"Smith","year":"2013","journal-title":"Aust Health Rev"},{"key":"2026062905094394200_dkag212-B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2024.105144","article-title":"Surveillance of antimicrobial use in long-term care facilities: an antimicrobial mapping survey","volume":"25","author":"Maher","year":"2024","journal-title":"J Am Med Dir Assoc"},{"key":"2026062905094394200_dkag212-B28","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1093\/jac\/dks085","article-title":"Antimicrobial prescribing in residential homes","volume":"67","author":"McClean","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"2026062905094394200_dkag212-B29","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/2047-2994-3-6","article-title":"Antimicrobial stewardship in long term care facilities: what is effective?","volume":"3","author":"Nicolle","year":"2014","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026062905094394200_dkag212-B30","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.46.1800100","article-title":"Antimicrobial prescribing in long-term care facilities: a nationwide point-prevalence study, Slovenia, 2016","volume":"23","author":"Stepan","year":"2018","journal-title":"Euro Surveill"},{"key":"2026062905094394200_dkag212-B31","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1111\/ggi.13776","article-title":"Inadequate empirical antimicrobial treatment in older people with bacteremic urinary tract infection who reside in nursing homes: a multicenter prospective observational study","volume":"19","author":"G\u00f3mez Belda","year":"2019","journal-title":"Geriatr Gerontol Int"},{"key":"2026062905094394200_dkag212-B32","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17093282","article-title":"Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from Australian residential aged care services","volume":"17","author":"Sluggett","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026062905094394200_dkag212-B33","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1017\/ice.2024.120","article-title":"Antibiogram development for Australian residential aged care facilities","volume":"45","author":"Khatri","year":"2024","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026062905094394200_dkag212-B34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-075566","article-title":"Reducing unnecessary urine culture testing in residents of long term care facilities","volume":"382","author":"Piggott","year":"2023","journal-title":"BMJ"},{"key":"2026062905094394200_dkag212-B35","doi-asserted-by":"publisher","first-page":"1620","DOI":"10.1093\/cid\/ciz482","article-title":"The urine-culturing cascade: variation in nursing home urine culturing and association with antibiotic use and Clostridiodes difficile infection","volume":"70","author":"Brown","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026062905094394200_dkag212-B36","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s40266-015-0292-7","article-title":"Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement","volume":"32","author":"Crnich","year":"2015","journal-title":"Drugs Aging"},{"key":"2026062905094394200_dkag212-B37","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics14020208","article-title":"Temporal trends of Escherichia coli antimicrobial resistance and antibiotic utilization in Australian long-term care facilities","volume":"14","author":"Smit","year":"2025","journal-title":"Antibiotics"},{"key":"2026062905094394200_dkag212-B38","author":"Therapeutic Guidelines Antibiotic Expert Group 2025"},{"key":"2026062905094394200_dkag212-B39","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jhin.2018.10.013","article-title":"Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review","volume":"102","author":"Jones","year":"2019","journal-title":"J Hosp Infect"},{"key":"2026062905094394200_dkag212-B40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002156","article-title":"Development of quality indicators for the diagnosis and treatment of urinary tract infections in general practice: a RAND appropriateness method","volume":"12","author":"Saust","year":"2023","journal-title":"BMJ Open Qual"},{"key":"2026062905094394200_dkag212-B41","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10030316","article-title":"Quality of the diagnostic process, treatment decision, and predictors for antibiotic use in general practice for nursing home residents with suspected urinary tract infection","volume":"10","author":"Sommer-Larsen","year":"2021","journal-title":"Antibiotics"},{"key":"2026062905094394200_dkag212-B42","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/9406499","article-title":"Timeliness of microbiology test result reporting and association with outcomes of adults hospitalised with unspecified pneumonia: a data linkage study","volume":"2022","author":"Shrestha","year":"2022","journal-title":"Int J Clin Pract"},{"key":"2026062905094394200_dkag212-B43","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1111\/jgs.18778","article-title":"Diagnostic uncertainty and decision-making in home-based primary care: a qualitative study of antibiotic prescribing","volume":"72","author":"Datta","year":"2024","journal-title":"J Am Geriatr Soc"},{"key":"2026062905094394200_dkag212-B44","author":"Australian Commission of Safety and Quality in Health Care (ACSQHC) 2024"},{"key":"2026062905094394200_dkag212-B45","author":"Aged Care Quality and Safety Commission 2025"},{"key":"2026062905094394200_dkag212-B46","doi-asserted-by":"publisher","volume":"48","author":"Javanparast","DOI":"10.1007\/s11096-025-01991-3"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/81\/7\/dkag212\/68642563\/dkag212.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/81\/7\/dkag212\/68642563\/dkag212.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T09:09:51Z","timestamp":1782724191000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/doi\/10.1093\/jac\/dkag212\/8721403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":46,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,6,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkag212","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,6,3]]},"article-number":"dkag212"}}