Antimicrobial Stewardship
Section snippets
Antimicrobial stewardship
The overuse and misuse of antimicrobial agents has detrimental effects on the individual patient, the health care system, and society as a whole. Amongst other negative consequences, inappropriate antimicrobial use contributes to the increasing costs of health care, the emergence of multidrug resistant organisms (MDROs), and unnecessary adverse drug reactions. The implementation of a monitoring and intervention system is vital to optimize the effectiveness of currently available antimicrobial
What is antimicrobial stewardship?
Antimicrobial stewardship refers to a program or series of interventions to monitor and direct antimicrobial use at a health care institution, thus providing a standard, evidence-based approach to judicious antimicrobial use. The most effective antimicrobial stewardship programs simultaneously incorporate multiple strategies after collaborating with the various specialties within a given health care facility, although interventions on a smaller scale to improve antimicrobial use are also
The goals of antimicrobial stewardship
There are multiple goals of antimicrobial stewardship programs. From a public health standpoint, reduction of emergence of antimicrobial resistance and preservation of existing and future antimicrobial agents are a priority. Although there are several examples of stewardship approaches in the literature that have led to decreases in unnecessary antimicrobial use, there are fewer that have reported short-term reductions in antimicrobial resistance, and even fewer, if any, that have reported
Essential participants in an antimicrobial stewardship program
The next sections detail some of the important members of the team needed to initiate and sustain a stewardship program. The final composition of the program depends on available resources as well as its activities and goals.
Antimicrobial stewardship strategies
Several interventions have been evaluated to promote the judicious use of antimicrobials, including education, clinical guidelines, preprescription approval, postprescription review, computer-based decision support, and antibiotic cycling. Health care institutions with stewardship programs in place often use various combinations of these strategies, making strict classification, as well as evaluation, of stewardship programs not always feasible.
Barriers to implementation and maintenance of stewardship programs
There are several barriers that may interfere with the initiation as well as continued maintenance of a stewardship program. Although most physicians recognize emergence of MDROs as an important problem, they are primarily concerned with their individual patients’ clinical outcomes related to antibiotics and rate the risk of development of antimicrobial resistance as the factor least likely to influence their antimicrobial choices.57 Because rates of antimicrobial resistance continue to
Making a business case for antimicrobial stewardship
There is currently no direct reimbursement to hospitals for establishing an antimicrobial stewardship program. Therefore, it is often necessary to make a business case to hospital administration for such a program to be created. The plans put forth from physicians, pharmacists, and others interested in initiating a stewardship program cannot be materialized without at least passive endorsement by hospital leadership. It may also be helpful to remind hospital administrators that the Joint
Measuring the effect of the program
Most stewardship programs need to provide some evidence to institutional administration that they are improving care and/or reducing costs. It is important to establish at the time of initiation of the program what goals are expected. As changing behavior regarding antimicrobial use is challenging, the initial goals should be modest and directed at a reduction in use of one or a few antimicrobial agents rather than decreasing the use of all agents or decreasing antimicrobial resistance rates.
Summary
Antimicrobial stewardship programs consist of ongoing efforts by health care institutions to optimize antimicrobial use, with the goals of improving patient outcomes, promoting cost-effective therapy, reducing untoward effects of unnecessary antimicrobials, and limiting the production of MDROs. Antimicrobial resistance is a serious threat that is exacerbated by the gradual withdrawal of the pharmaceutical industry from new antibiotic agent development. We are currently faced with a serious need
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Funding support: no funding was obtained for this review.