Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: Results of a consensus conference

Establishing a clinical diagnosis of infection in residents of long-term-ca re facilities (LTCFs) is difficult. As a result, deciding when to initiate antibiotics can be particularly challenging. This article describes the est ablishment of minimum criteria for the initiation of antibiotics in residen ts of LTCFs. Experts in this area were invited to participate in a consensu s conference. Using a modified delphi approach, a questionnaire and selecte d relevant articles were sent to participants who were asked to rank indivi dual signs and symptoms with respect to their relative importance. Using th e results of the weighting by participants, a modification of the nominal g roup process was used to achieve consensus. Criteria for initiating antibio tics for skin and soft-tissue infections, respiratory infections, urinary i nfections, and fever where the focus of infection is unknown were developed .