{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T14:06:32Z","timestamp":1779458792388,"version":"3.53.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The aging population has led to an increased number of people in nursing homes (NHs). The use of antimicrobials in this setting carries an increased risk of adverse events and interactions, particularly in individuals with advanced age, comorbidities, and polypharmacy. Antimicrobial Stewardship Programs (ASPs) have been shown to reduce the consumption of these drugs, improve prescribing practices, and have a positive ecological impact. However, the implementation of ASPs in NHs remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and evaluate the impact of EduFAST web platform, which is designed to train professionals, monitor activities and provide ASP teams with periodic feedback and indicators of antimicrobial use and microbial resistance in NHs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Quasi-experimental, multicenter, before-and-after study. The intervention phase will last 12\u202fmonths and involves implementing ASP strategies (educational measures, indicator monitoring and periodic feedback) via the EduFAST web platform. Information will be collected on the use of the web platform, user satisfaction, knowledge gained and the number of website visits. To assess the impact of EduFAST\u2019s implementation, the following data will be recorded: clinical variables; antimicrobial consumption and prescription profiles; and the incidence of infections caused by multidrug-resistant bacteria and\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      . Additionally, the presence and concentration of antimicrobials, multidrug-resistant microorganisms and resistance genes in wastewater from the participating centers will be recorded to evaluate the correlation between clinical samples, antimicrobial consumption and wastewater findings, as well as the environmental impact of the intervention. The intervention\u2019s impact will be analyzed through interrupted time series analysis, trend analysis, mixed linear regression models and correlation analysis for data obtained from wastewater samples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The aim of this project is to facilitate the implementation and sustainability of ASPs through the development of a national-level website. Wastewater analysis will provide insight into the correlation between antimicrobial consumption, microbial resistance, and the environment from a one-health perspective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1787035","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:22:30Z","timestamp":1779456150000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Education and regular Feedback for Antimicrobial Stewardship in nursing homes: EduFAST study protocol"],"prefix":"10.3389","volume":"13","author":[{"given":"Irene","family":"Sotillo-S\u00e1nchez","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Herrera-Hidalgo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]},{"name":"Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cintia","family":"Flores-Rubio","sequence":"additional","affiliation":[{"name":"Mass Spectrometry Laboratory\/Organic Pollutants, Institute of Environmental Assessment and Water Research, IDAEA-CSIC","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"G\u00e1lvez-Ben\u00edtez","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]},{"name":"Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Mar\u00eda","family":"Herrera-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Mass Spectrometry Laboratory\/Organic Pollutants, Institute of Environmental Assessment and Water Research, IDAEA-CSIC","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germ\u00e1n","family":"Pe\u00f1alva-Moreno","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]},{"name":"Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Mej\u00edas-Trueba","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]},{"name":"Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didiana","family":"Jaramillo-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"de la Casa-Resino","sequence":"additional","affiliation":[{"name":"Spanish National Action Plan on Antimicrobial Resistance (PRAN), Spanish Agency of Medicines and Medical Devices","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reyes","family":"Castillo-V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Spanish National Action Plan on Antimicrobial Resistance (PRAN), Spanish Agency of Medicines and Medical Devices","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Ciudad-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Victoria","family":"Gil-Navarro","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Bel\u00e9n","family":"Guisado-Gil","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Institute of Biomedicine of Seville, Virgen del Rocio University Hospital\/CSIC\/University of Seville","place":["Seville, Spain"]},{"name":"Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocio University Hospital","place":["Seville, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1007\/s41999-021-00531-2","article-title":"Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses","volume":"12","author":"Giri","year":"2021","journal-title":"Eur Geriatr Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"680","DOI":"10.3390\/antibiotics10060680","article-title":"Prevalence and risk factors for multidrug-resistant organisms colonization in long-term care facilities around the world: a review","volume":"10","author":"Rodr\u00edguez-Villodres","year":"2021","journal-title":"Antibiotics (Basel)."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1086\/595683","article-title":"Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America","volume":"48","author":"High","year":"2009","journal-title":"Clin Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ajic.2019.07.015","article-title":"Characteristics of nursing homes with comprehensive antibiotic stewardship programs: results of a national survey","volume":"48","author":"Fu","year":"2020","journal-title":"Am J Infect Control"},{"key":"ref5","volume-title":"Antimicrobial Stewardship Interventions: A Practical Guide","year":"2021"},{"key":"ref6","volume-title":"Proposals for EU Guidelines on the Prudent Use of Antimicrobials in Humans","year":"2017"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1093\/jac\/dkaa013","article-title":"Antimicrobial stewardship programmes in nursing homes: a systematic review and inventory of tools","volume":"75","author":"Belan","year":"2020","journal-title":"J Antimicrob Chemother"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1016\/j.cmi.2021.06.003","article-title":"Are antimicrobial stewardship interventions effective and safe in long-term care facilities? A systematic review and meta-analysis","volume":"27","author":"Crespo-Rivas","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1177\/07334648211018299","article-title":"Antimicrobial stewardship interventions to optimize treatment of infections in nursing home residents: a systematic review and meta-analysis","volume":"41","author":"Aliyu","year":"2022","journal-title":"J Appl Gerontol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jamda.2017.06.019","article-title":"Antibiotic stewardship programs in nursing homes: a systematic review","volume":"19","author":"Feldstein","year":"2018","journal-title":"J Am Med Dir Assoc"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"100418","DOI":"10.1016\/j.idh.2026.100418","article-title":"Antibiotic use in nursing homes: a qualitative study on knowledge and attitudes among assistant nurses', nurses' and general practitioners","volume":"31","author":"Dumartin","year":"2026","journal-title":"Infect Dis Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jgar.2022.02.002","article-title":"Impact of antimicrobial stewardship program on antimicrobial-resistance and prescribing in nursing homes: a systematic review and meta-analysis","volume":"29","author":"Tandan","year":"2022","journal-title":"J Glob Antimicrob Resist"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1093\/cid\/ciac834","article-title":"Clinical and ecological impact of an educational program to optimize antibiotic treatments in nursing homes (PROA-SENIOR): a cluster, randomized, controlled trial and interrupted time-series analysis","volume":"76","author":"Pe\u00f1alva","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1126\/science.abp9554","article-title":"Greening the pharmacy","volume":"377","author":"Orive","year":"2022","journal-title":"Science"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"791","DOI":"10.5498\/wjp.v11.i10.791","article-title":"Environmental pollution with psychiatric drugs","volume":"11","author":"Argaluza","year":"2021","journal-title":"World J Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"114621","DOI":"10.1016\/j.ijheh.2025.114621","article-title":"Influence of antimicrobial consumption (AMC) on the detection of antimicrobial resistance genes (ARGs) in urban wastewater","volume":"268","author":"Leal","year":"2025","journal-title":"Int J Hyg Environ Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jacamr\/dlaf070","article-title":"The association between antibiotic use in hospitals and residual antibiotic concentrations in hospital effluents: a pilot study","volume":"7","author":"Deedat","year":"2025","journal-title":"JAC Antimicrob Resist"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"803","DOI":"10.3389\/fmicb.2015.00803","article-title":"Potential impacts of aquatic pollutants: sub-clinical antibiotic concentrations induce genome changes and promote antibiotic resistance","volume":"6","author":"Chow","year":"2015","journal-title":"Front Microbiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e02658","DOI":"10.1128\/AAC.02658-20","article-title":"Antioxidant molecules as a source of mitigation of antibiotic resistance gene dissemination","volume":"65","author":"Ortiz de la Rosa","year":"2021","journal-title":"Antimicrob Agents Chemother"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"849","DOI":"10.3390\/antibiotics11070849","article-title":"Review of antimicrobial resistance in wastewater in Japan: current challenges and future perspectives","volume":"11","author":"Baba","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"705","DOI":"10.2166\/wh.2021.112","article-title":"Prevalence of extended-spectrum \u03b2-lactamase (ESBL)-producing Enterobacteriaceae in wastewater: a systematic review and meta-analysis","volume":"19","author":"Zaatout","year":"2021","journal-title":"J Water Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"107171","DOI":"10.1016\/j.envint.2022.107171","article-title":"Systematic review of wastewater surveillance of antimicrobial resistance in human populations","volume":"162","author":"Chau","year":"2022","journal-title":"Environ Int"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3390\/antibiotics14020131","article-title":"The impact of wastewater on antimicrobial resistance: a scoping review of transmission pathways and contributing factors","volume":"14","author":"La Rosa","year":"2025","journal-title":"Antibiotics (Basel)."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"134885","DOI":"10.1016\/j.jhazmat.2024.134885","article-title":"Anthropogenic pollution may enhance natural transformation in water, favouring the spread of antibiotic resistance genes","volume":"475","author":"Sivalingam","year":"2024","journal-title":"J Hazard Mater"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1038\/s41467-019-08853-3","article-title":"Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage","volume":"10","author":"Hendriksen","year":"2019","journal-title":"Nat Commun"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1126\/science.aba3432","article-title":"Using sewage for surveillance of antimicrobial resistance","volume":"367","author":"Aarestrup","year":"2020","journal-title":"Science"},{"key":"ref27","year":"2025"},{"key":"ref28","article-title":"The European committee on antimicrobial susceptibility testing","year":"2025"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1089\/mdr.2022.0264","article-title":"Evaluation of the MDR direct flow chip kit for the detection of multiple antimicrobial resistance determinants","volume":"29","author":"Rodr\u00edguez-Villodres","year":"2023","journal-title":"Microb Drug Resist"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1093\/jac\/dkae146","article-title":"Barriers to the implementation of antimicrobial stewardship programmes in long-term care facilities: a scoping review","volume":"79","author":"Vicentini","year":"2024","journal-title":"J Antimicrob Chemother"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.cmi.2019.07.009","article-title":"Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the public health system of Andalusia, Spain: an ecologic study of time-trend analysis","volume":"26","author":"Rodr\u00edguez-Ba\u00f1o","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/S1473-3099(19)30573-0","article-title":"Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum \u03b2-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis","volume":"20","author":"Pe\u00f1alva","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"ref33","volume-title":"Plan Nacional frente a la Resistencia a los Antibi\u00f3ticos 2025\u20132027","year":"2025"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.eimce.2022.05.013","article-title":"Antimicrobial stewardship in hospitals: expert recommendation guidance document for activities in specific populations, syndromes and other aspects (PROA-2) from SEIMC, SEFH, SEMPSPGS, SEMICYUC and SEIP","volume":"41","author":"Cercenado","year":"2023","journal-title":"Enferm Infecc Microbiol Clin (Engl Ed)"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1001\/jamainternmed.2020.1256","article-title":"A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents","volume":"180","author":"Nace","year":"2020","journal-title":"JAMA Intern Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jamda.2020.07.040","article-title":"Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment","volume":"22","author":"Hanlon","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1016\/S1473-3099(21)00001-3","article-title":"Effectiveness of a tailored intervention to reduce antibiotics for urinary tract infections in nursing home residents: a cluster, randomised controlled trial","volume":"21","author":"Arnold","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1136\/bmj.38602.586343.55","article-title":"Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial","volume":"331","author":"Loeb","year":"2005","journal-title":"BMJ"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1001\/jamainternmed.2021.3098","article-title":"The trial to reduce antimicrobial use in nursing home residents with Alzheimer disease and other dementias (TRAIN-AD): a cluster randomized clinical trial","volume":"181","author":"Mitchell","year":"2021","journal-title":"JAMA Intern Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1111\/jgs.16059","article-title":"A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes","volume":"68","author":"Sloane","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.cmi.2023.12.020","article-title":"Assessment of implementation strategies adopted for antimicrobial stewardship interventions in long-term care facilities: a systematic review","volume":"30","author":"Conlin","year":"2024","journal-title":"Clin Microbiol Infect"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"126950","DOI":"10.1016\/j.envpol.2025.126950","article-title":"Wastewater-based surveillance reveals distinct resistome profiles in younger and older populations","volume":"384","author":"Wang","year":"2025","journal-title":"Environ Pollut"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"123706","DOI":"10.1016\/j.watres.2025.123706","article-title":"Quantitative study of ESBL and carbapenemase producers in wastewater treatment plants in Seville, Spain: a culture-based detection analysis of raw and treated water","volume":"281","author":"Monge-Olivares","year":"2025","journal-title":"Water Res"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1787035\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:22:32Z","timestamp":1779456152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1787035\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":43,"alternative-id":["10.3389\/fmed.2026.1787035"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1787035","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"article-number":"1787035"}}