National Inventory Identifies Critical Gaps in French Nursing Home Stewardship Tools

A nationwide inventory of antimicrobial stewardship tools across France identified 96 resources specifically designed for nursing homes from 541 total tools mapped across 238 organisation websites, revealing significant structural gaps in coverage. The findings highlight that while materials exist to guide antibiotic use in residential elderly care, key operational domains remain unaddressed.

Antimicrobial stewardship tools are intended to support safe and effective antimicrobial prescribing in nursing homes, but accessibility in France has been hindered by the wide variety of stakeholders developing them. To systematically evaluate and catalog these resources, researchers developed the ORANEAT inventory method and applied it across French nursing home settings.

The investigators used an inductive approach to map organisations engaged in antimicrobial stewardship at local, regional, and national levels in France, searching their websites through February 2025. Tools were defined as materials used by healthcare professionals and other stakeholders to initiate or expand stewardship activities in nursing homes. The team characterised selected materials using a tailored TIDieR checklist, generated characteristics via the constant comparative method, integrated the CDC core elements of antibiotic stewardship for nursing homes, and conducted a network analysis to examine inter-organisational collaborations.

Analysis of the 96 nursing home tools revealed that stewardship resources predominantly aligned with only two CDC core elements: education, addressed by 58 tools (60.4 percent), and actions to improve antibiotic use, addressed by 39 tools (40.6 percent). In contrast, tracking was supported by just 5 tools (5.2 percent), drug expertise by 2 tools (2.1 percent), and leadership commitment by 1 tool (1 percent), while none of the surveyed tools addressed accountability or reporting.

The inventory also identified substantial imbalances in the intended audiences and clinical focuses of the available materials. Nurses were the most frequent target group, cited in 62 tools (64.6 percent), followed by general practitioners and prescribers in 49 tools (51 percent), and assistant nurses in 39 tools (40.6 percent), whereas only 9 tools (9.4 percent) offered resources for residents or their families. In terms of medical indications, urinary tract infections represented the primary clinical subject, accounting for 41 tools (42.7 percent).

Furthermore, the network analysis demonstrated limited institutional collaboration, with only 26 tools (27.1 percent) produced through cross-organisational efforts. The study authors concluded that the ORANEAT inventory method offers a systematic way to review nursing home stewardship tools at a national scale, identifying crucial deficits in leadership commitment, accountability, tracking, and reporting that require coordinated development and enhanced partnership across organisations.

Subject of Research: Inventory and characterisation of antimicrobial stewardship tools for nursing homes in France

Article Title: Mapping and characterisation of antimicrobial stewardship tools for nursing homes in France: the ORANEAT inventory method

Article References: Jacquet, N., Bouges, S., Conlin, M., Gonthier, D., Marquet, A., Boutfol, W., Dumartin, C., Castel, P., Agrinier, N., Birgand, G., The ORANEAT Study Group, Agrinier, N., Birgand, G., Castel, P., Claudot, F., Dumartin, C., Epstein, J., & Ricci, L. (2026). Mapping and characterisation of antimicrobial stewardship tools for nursing homes in France: the ORANEAT inventory method. Antimicrobial Resistance & Infection Control. https://doi.org/10.1186/s13756-026-01852-2

Image Credits: AI Generated

DOI: 10.1186/s13756-026-01852-2

Keywords: antimicrobial stewardship, nursing homes, France, infection control, ORANEAT, healthcare professionals, antibiotic prescribing, urinary tract infections, Mapping, characterisation, antimicrobial, stewardship