Antimicrobial stewardship: what is it, and how does it work?

2015 ◽  
Vol 55 (12) ◽  
pp. 1432 ◽  
Author(s):  
J. Turnidge
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Local Level ◽  
Animal Health ◽  
Public Hospitals ◽  
Audit And Feedback ◽  
Management Tool ◽  
Laboratory Services ◽  
Stewardship Program ◽  
Wide Range

Antimicrobial stewardship is emerging as a vital management tool in the efforts to contain antimicrobial resistance and retain the efficacy of available agents. It is based on a set of concepts about antimicrobial use and resistance that have been developed over the past 70 years. There are seven basic requirements for a stewardship program to function at a local level, including (1) ‘executive’ ownership of the issue, (2) consensus prescribing guidelines, (3) a local formulary with various levels of restricted access, (4) a local champion (or champions) who is a trusted peer, (5) authority to intervene in prescribing and/or dispensing, (6) authority for measurement of use, audit and feedback, and (7) access to reliable laboratory services and their cumulative resistance data. Stewardship programs are most advanced in larger public hospitals, but there is considerable interest and need for developing programs tailored to a wide range of settings in human and animal health, each with their own particular characteristics of access to antimicrobials and potential controls. The potential value of stewardship in food animal production is now recognised globally, and Australia has taken the first steps towards surveillance and stewardship in this sector, supported by a recently released national One Health strategy on the containment of antimicrobial resistance.

Impact of a Comprehensive Antimicrobial Stewardship Program on Institutional Burden of Antimicrobial Resistance: A 14-Year Controlled Interrupted Time-series Study

2019 ◽  
Vol 71 (11) ◽  
pp. 2897-2904 ◽  
Author(s):  
Christine Peragine ◽  
Sandra A N Walker ◽  
Andrew Simor ◽  
Scott E Walker ◽  
Alexander Kiss ◽  
...  
Keyword(s):  
Time Series ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Audit And Feedback ◽  
Time Series Study ◽  
Stewardship Program ◽  
Hospital Acquired ◽  
Series Study

Abstract Background Antimicrobial resistance (AMR) constitutes an international public health threat widely believed to result from excessive antimicrobial use (AMU). Numerous authorities have recommended antimicrobial stewardship programs (ASPs) to curb the selection of AMR, but there is a lack of data confirming this benefit. Methods A controlled interrupted time-series study spanning 14 years was performed to assess impact of a comprehensive hospital-based ASP that included pharmacist-led audit and feedback on institutional AMR. Patient-level microbiologic and AMU data were obtained from October 2002 to September 2016. Poisson regression models were used to identify changes in the incidence and trend of hospital-acquired (HA) antibiotic-resistant organisms (AROs) and multidrug-resistant organisms (MDROs). Changes in community-acquired (CA)–ARO, CA-MDRO, and inpatient AMU were assessed as controls and process outcomes. Results Statistically significant shifts in AMU, HA-ARO, and HA-MDRO trends coinciding with ASP implementation were observed, corresponding with a 9% reduction in HA-ARO burden (incidence rate ratio [IRR], 0.91 [95% confidence interval {CI}, .83–.99]; P = .03) and a 13% reduction in HA-MDRO burden (IRR, 0.87 [95% CI, .73–1.04]; P = .13) in the intervention period. In contrast, CA-ARO and CA-MDRO incidence continued to rise, with 40% (IRR, 1.40 [95% CI, 1.28–1.54]; P < .0001) and 68% (IRR, 1.68 [95% CI, 1.57–1.82]; P < .0001) increases in burden found, respectively. Conclusions Implementation of a comprehensive ASP resulting in reduced AMU was associated with a significant reduction in institutional AMR, even though community AMR increased during the same period. These results confirm that ASPs play an important role in the fight against AMR.

scholarly journals 2027. What Are the Views Among Pakistani Physicians Toward Antimicrobial Resistance and Hospital Antimicrobial Stewardship Programs? A Multi-Site Qualitative Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S681-S681
Author(s):  
Khezar Hayat ◽  
Meagen Rosenthal ◽  
Ali Hassan Gillani ◽  
Panpan Zhai ◽  
Wenjing Ji ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Public Hospitals ◽  
Teaching Hospitals ◽  
Public Health Issue ◽  
Antibiotic Prescribing ◽  
Healthcare Facilities ◽  
Face To Face ◽  
Stewardship Program

Abstract Background Antimicrobial resistance (AMR) is a major public health issue that the world is facing in the 21st century and implementation of antimicrobial stewardship program (ASP) is one of the recognized approaches to combat AMR. Little is known on the views among Pakistani physicians regarding AMR and the benefits of hospital ASP implementation. This study was aimed to investigate the perception and attitude of physicians about AMR and ASP. Methods Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio-recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis conducted. Results Three major themes were identified: (1) the growing concern of AMR in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing and infection control, and (3) managing antibiotic resistance in hospitals. Poor healthcare facilities, insufficient trained medical staff, and inadequate resources were the key barriers in the implementation of ASP in Pakistan. Conclusion Physicians of public sector tertiary care teaching hospitals have shown poor familiarity toward hospital ASPs but the concept of hospital ASPs in Pakistan can be established by using the distinct themes that originated during this study. Overall, the attitude of physicians was positive toward its enforcement in all types of hospital settings including teaching hospitals. Disclosures All authors: No reported disclosures.

scholarly journals Perspective of Pakistani Physicians towards Hospital Antimicrobial Stewardship Programs: A Multisite Exploratory Qualitative Study

2019 ◽  
Vol 16 (9) ◽  
pp. 1565 ◽  
Author(s):  
Khezar Hayat ◽  
Meagen Rosenthal ◽  
Ali Hassan Gillani ◽  
Panpan Zhai ◽  
Muhammad Majid Aziz ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Public Hospitals ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Healthcare Facilities ◽  
Healthcare Settings ◽  
Stewardship Program ◽  
Global Threat

Background: Antimicrobial resistance (AMR) is a global threat and the antimicrobial stewardship program (ASP) is a globally used tool to combat AMR. There is little information on the views among Pakistani physicians regarding AMR and the benefits of hospital antimicrobial stewardship implementation. This study was designed to explore the physicians’ views about ASP. Methods: Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis was conducted. Results: Three broad themes were identified: (1) the growing concern of antimicrobial resistance in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing, and (3) managing antibiotic resistance in hospitals. Inadequate resources, poor healthcare facilities, and insufficiently trained medical staff were the major hurdles in ASP implementation in Pakistan. Conclusions: Our study found a poor familiarity of hospital ASP among physicians working in public sector tertiary care teaching hospitals, and a number of distinct themes emerged during this study that could be helpful in establishing the concept of hospital ASP in Pakistan. Overall, physicians showed a positive attitude towards the enforcement of ASP in all healthcare settings, including teaching hospitals.

scholarly journals Implementation of an Antimicrobial Stewardship Program in Five Colombian Hospitals in 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s273-s273
Author(s):  
Christian Pallares ◽  
María Virginia Villegas Botero
Keyword(s):  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Control Strategies ◽  
Education And Training ◽  
Public Hospitals ◽  
International Standards ◽  
International Consensus ◽  
Stewardship Program ◽  
And Training

Background: More than 50% of antibiotics used in hospitals are unnecessary or inappropriate. The antimicrobial stewardship programs (ASPs) are coordinated efforts to promote the rational and effective use of antibiotics including appropriate selection, dosage, administration, and duration of therapy. When an ASP integrates infection control strategies, it is possible to decrease the transmission of multidrug-resistant pathogens. Methods: In 2018, 5 Colombian hospitals were selected to implement an ASP. Private and public hospitals from different cities were included in the study, ranging from 200 to 700 beds. Our team, consisting of an infectious disease and hospital epidemiologist, visited each hospital to establish the baseline of their ASP program, to define the ASP outcomes according to each hospital’s needs, and to set goals for ASP outcomes in the following 6–12 months. Follow-up was scheduled every 2 months through Skype video conference. The baseline diagnosis or preintervention evaluation was done using a tool adapted from previous reports (ie, international consensus and The Joint Commission international standards). Documentation related to ASPs, such as microbiological profiles, antimicrobial guidelines (AMG) and indicators for the adherence to them as well as antimicrobial resistance (AMR) prevention through protocols, were written and/or updated. Prevention and infection control requirements and protocols were also updated, and cleaning and antiseptic policies were created. Training in rational use of antibiotic, infection control and prevention, and cleaning and disinfection were carried out with the healthcare workers in each institution. Results: Before the intervention, the development of the ASP according to the tool was 27% (range, 5%–47%). The lowest institutional scores were the item related to ASP feedback and reports (11% on average), followed by education and training (14%), defined ASP responsibilities (23%), ASP function according to priorities (26%), and AMR surveillance (27%). After the intervention, the ASP development increased to 57% (range, 39%–81%) in the hospitals. The highest scores achieved were for education and training (90%), surveillance (75%), and the activities of the infection control committee (70%). The items that made the greatest contribution to ASP development were the individual antibiogram, including the bacteria resistance profile, and the development of the AMG based on the local epidemiology in each hospital. Conclusions: The implementation of an ASP should include training and education as well as defining outcomes according to the hospital’s needs. Once the strategy is implemented, follow-up is key to achieving the goals.Funding: NoneDisclosures: None

scholarly journals Knowledge, Attitudes and Practices of Veterinarians Towards Antimicrobial Resistance and Stewardship in Nigeria

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 453
Author(s):  
Usman O. Adekanye ◽  
Abel B. Ekiri ◽  
Erika Galipó ◽  
Abubakar Bala Muhammad ◽  
Ana Mateus ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Action Plan ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Health Concern ◽  
Attitudes And Practices ◽  
Laboratory Services ◽  
Knowledge Attitudes And Practices

Antimicrobial resistance (AMR) is a global health concern and the inappropriate use of antibiotics in animals and humans is considered a contributing factor. A cross-sectional survey to assess the knowledge, attitudes and practices of veterinarians regarding AMR and antimicrobial stewardship was conducted in Nigeria. A total of 241 respondents completed an online survey. Only 21% of respondents correctly defined the term antimicrobial stewardship and 59.8% were unaware of the guidelines provided by the Nigeria AMR National Action Plan. Over half (51%) of the respondents indicated that prophylactic antibiotic use was appropriate when farm biosecurity was poor. Only 20% of the respondents conducted antimicrobial susceptibility testing (AST) frequently, and the unavailability of veterinary laboratory services (82%) and the owner’s inability to pay (72%) were reported as key barriers to conducting AST. The study findings suggest strategies focusing on the following areas may be useful in improving appropriate antibiotic use and antimicrobial stewardship among veterinarians in Nigeria: increased awareness of responsible antimicrobial use among practicing and newly graduated veterinarians, increased dissemination of regularly updated antibiotic use guidelines, increased understanding of the role of good biosecurity and vaccination practices in disease prevention, and increased provision of laboratory services and AST at affordable costs.

Clinical impact of a pharmacist-led antimicrobial stewardship initiative evaluating patients with Clostridioides difficile colitis

2020 ◽  
Vol 68 (4) ◽  
pp. 888-892 ◽  
Author(s):  
Paige A Bishop ◽  
Carmen Isache ◽  
Yvette S McCarter ◽  
Carmen Smotherman ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Clinical Success ◽  
Audit And Feedback ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Usa ◽  
The Impact

Clostridioides difficile is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficile infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

scholarly journals Building the European Antimicrobial Resistance Surveillance network in veterinary medicine (EARS-Vet)

2021 ◽  
Vol 26 (4) ◽  
Author(s):  
Rodolphe Mader ◽  
Peter Damborg ◽  
Jean-Philippe Amat ◽  
Björn Bengtsson ◽  
Clémence Bourély ◽  
...  
Keyword(s):  
Veterinary Medicine ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
One Health ◽  
Action Plan ◽  
Animal Health ◽  
World Health ◽  
European Economic Area ◽  
Surveillance Network ◽  
Antimicrobial Resistance Surveillance

Antimicrobial resistance (AMR) should be tackled through a One Health approach, as stated in the World Health Organization Global Action Plan on AMR. We describe the landscape of AMR surveillance in the European Union/European Economic Area (EU/EEA) and underline a gap regarding veterinary medicine. Current AMR surveillance efforts are of limited help to veterinary practitioners and policymakers seeking to improve antimicrobial stewardship in animal health. We propose to establish the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) to report on the AMR situation, follow AMR trends and detect emerging AMR in selected bacterial pathogens of animals. This information could be useful to advise policymakers, explore efficacy of interventions, support antimicrobial stewardship initiatives, (re-)evaluate marketing authorisations of antimicrobials, generate epidemiological cut-off values, assess risk of zoonotic AMR transmission and evaluate the burden of AMR in animal health. EARS-Vet could be integrated with other AMR monitoring systems in the animal and medical sectors to ensure a One Health approach. Herein, we present a strategy to establish EARS-Vet as a network of national surveillance systems and highlight challenges of data harmonisation and bias. Strong political commitment at national and EU/EEA levels is required for the success of EARS-Vet.

scholarly journals Views of Community Pharmacists on Antimicrobial Resistance and Antimicrobial Stewardship in Jordan: A Qualitative Study

2021 ◽  
Author(s):  
Doaa Saleh ◽  
Rana Abu Farha ◽  
Tareq Mukattash ◽  
Muna Barakat ◽  
Eman Alefishat
Keyword(s):  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Antimicrobial Stewardship ◽  
Action Plan ◽  
Pharmacy Practice ◽  
Community Pharmacists ◽  
Academic Disciplines ◽  
World Health ◽  
Community Pharmacies ◽  
Stewardship Program

The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main basis of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convienience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed good understanding about the causes of antimicrobial resistance. The most important causes reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, including organizational obstacles, resources obstacles, and personal obstacles. As a conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.

Sign in / Sign up

Export Citation Format

Share Document