What is antimicrobial stewardship? Dyar, O.J.; Huttner, B.; Schouten, J. ...
Clinical microbiology and infection,
11/2017, Letnik:
23, Številka:
11
Journal Article
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The use of the term ‘antimicrobial stewardship’ has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although ...antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and One Health. As the use of the term ‘antimicrobial stewardship’ becomes more common, it is important to consider what antimicrobial stewardship is, as well as what it is not.
To review the emergence and evolution of the term ‘antimicrobial stewardship’.
We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We contacted the authors of the first publications that mentioned antimicrobial stewardship.
We describe the historical background behind how antimicrobial stewardship came into use in clinical settings. We discuss challenges emerging from the varied descriptions of antimicrobial stewardship in the literature, including an over-emphasis on individual prescriptions, an under-emphasis on the societal implications of antimicrobial use, and language translation problems.
To help address these challenges, we suggest viewing antimicrobial stewardship as a strategy, a coherent set of actions which promote using antimicrobials responsibly. We stress the continuous need for ‘responsible use’ to be defined and translated into context-specific and time-specific actions. Furthermore, we present examples of actions that can be undertaken within antimicrobial stewardship across human and animal health.
As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use ...considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.
Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure optimal use of antimicrobials to improve patient outcomes, while limiting the risk of adverse events (including ...antimicrobial resistance (AMR)). Introduction of AMS programmes in hospitals is part of most national action plans to mitigate AMR, yet the optimal components and actions of such a programme remain undetermined.
To describe how health-care professionals can start an AMS programme in their hospital, the components of such a programme and the evidence base for its implementation.
National and society-led guidelines on AMS, peer-reviewed publications and experience of AMS experts conducting AMS programmes.
We provide a step-by-step pragmatic guide to setting up and implementing a hospital AMS programme in high-income or low-and-middle-income countries.
Antimicrobial stewardship programmes in hospitals are a vital component of national action plans for AMR, and have been shown to significantly reduce AMR, particularly when coupled with infection prevention and control interventions. This step-by-step guide of ‘how to’ set up an AMS programme will help health-care professionals involved in AMS to optimally design and implement their actions.
CMI guidance for authors of surveys Pulcini, C.; Leibovici, L.
Clinical microbiology and infection,
November 2016, 2016-Nov, 2016-11-00, 20161101, Letnik:
22, Številka:
11
Journal Article
Our objective was to assess junior doctors' perceptions of their antibiotic prescribing practice and of bacterial resistance. We surveyed 190 postgraduate doctors still in training at two university ...teaching hospitals, in Nice (France) and Dundee (Scotland, UK), and 139 of them (73%) responded to the survey. The main results presented in this abstract are combined for Nice and Dundee, because there was no statistical difference for these points between the two hospitals. Antibiotic resistance was perceived as a national problem by 95% of the junior doctors, but only 63% rated the problem as important in their own daily practice. Their perceptions of the causes of antibiotic resistance were sometimes at variance with available medical evidence, with excessive duration of antibiotic treatment and poor hand hygiene practices rarely being perceived as important drivers for resistance. Only 31s% and 26% of the doctors knew the correct prevalences of antibiotic misuse and of methicillin-resistant Staphylococcus aureus in hospitals, respectively. They preferred educational interventions, such as specific teaching sessions, availability of guidelines or readily accessible advice from an infectious diseases specialist, to improve antibiotic prescribing, rather than restricted prescription of antibiotics. These data provide helpful information for the design of strategies to optimize adherence to good antimicrobial stewardship.
To report the extent and components of global efforts in antimicrobial stewardship (AMS) in hospitals.
An Internet-based survey comprising 43 questions was disseminated worldwide in 2012.
Responses ...were received from 660 hospitals in 67 countries: Africa, 44; Asia, 50; Europe, 361; North America, 72; Oceania, 30; and South and Central America, 103. National AMS standards existed in 52% of countries, 4% were planning them and 58% had an AMS programme. The main barriers to implementing AMS programmes were perceived to be a lack of funding or personnel, a lack of information technology and prescriber opposition. In hospitals with an existing AMS programme, AMS rounds existed in 64%; 81% restricted antimicrobials (carbapenems, 74.3%; quinolones, 64%; and cephalosporins, 58%); and 85% reported antimicrobial usage, with 55% linking data to resistance rates and 49% linking data to infection rates. Only 20% had electronic prescribing for all patients. A total of 89% of programmes educated their medical, nursing and pharmacy staff on AMS. Of the hospitals, 38% had formally reviewed their AMS programme: reductions were reported by 96% of hospitals for inappropriate prescribing, 86% for broad-spectrum antibiotic use, 80% for expenditure, 71% for healthcare-acquired infections, 65% for length of stay or mortality and 58% for bacterial resistance.
The worldwide development and implementation of AMS programmes varies considerably. Our results should inform and encourage the further evaluation of this with a view to promoting a worldwide stewardship framework. The prospective measurement of well-defined outcomes of the impact of these programmes remains a significant challenge.
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