The Antimicrobial Stewardship Initiative will assess current antibiotic surveillance processes in Australia including their appropriateness and effectiveness for assisting in the reduction of healthcare associated infections and limiting the increase in the prevalence of multi-resistant organisms. This project is informed by the findings and recommendations relating to multi-resistant organisms and antimicrobial usage in the publication Reducing harm to patients from health care associated infection: the role of antimicrobial stewardship in Australian hospitals.
Antimicrobial Stewardship Advisory Committee
The Antimicrobial Stewardship Advisory Committee has been established by the Commission to promote the optimal use of antimicrobials to maximise treatment efficacy in individuals while minimising the impact of antimicrobial resistance on communities.
- It provides advice on strategy options for effective antimicrobial stewardship programs for all sectors of the healthcare system; and
- Makes recommendations to the Commission on implementation and evaluation of the antimicrobial stewardship program.
The committee's focus is on developing and supporting strategies at a national, state, institutional and community level.
Antimicrobial Stewardship Advisory Committee Membership
- Dr Celia Cooper (Chair) - Clinical Director of Pathology & Head of Microbiology & Infectious Diseases, SA
- Dr Tara Anderson - Infectious Diseases Physician, Royal Hobart Hospital, TAS
- Dr Kirsty Buising - Infectious Diseases Physician & Clinical Research Fellow, VIC
- Dr John Ferguson - Area Director, Infection Prevention and Control, Hunter New England Health, NSW
- David Kong - Society of Hospital Pharmacists of Australia
- Dr David Looke - Senior Staff Specialist in Infectious Diseases & Associate Professor in the Department of Medicine, QLD
- Dr Morgyn Warner - Council of Australian Therapeutic Advisory Groups (CATAG)
- Dr Graeme Nimmo - Director, Microbiology, Royal Brisbane Hospital, QLD
- Dr Karin Thursky - Infectious Diseases Physician, VIC
- Professor John Turnidge - Chief, Division of Laboratory Medicine, SA
Inappropriate use of antimicrobials leads to the emergence of resistant bacteria, an increase in the risk of patient harm from avoidable drug toxicity, infection with multi-resistant bacteria, fungi or Clostridium difficile, and unnecessary costs. Patients with antimicrobial-resistant infections are more likely to experience ineffective treatment, recurrent infection, delayed recovery or even death. While over the last 40 years the prevalence of multidrug-resistant bacterial pathogens such as methicillin-resistant Staphylococcus aureus has risen alarmingly, in recent years few truly novel antimicrobials have been developed.
“As antimicrobial resistance increases and development of new antimicrobial agents declines, it is critical that antimicrobials are used wisely and judiciously.”
Studies show that up to 50% of antimicrobial regimens prescribed in hospitals, including Australian hospitals, are considered inappropriate. Comparison with data from northern Europe shows Australian hospitals have a higher overall rate of inpatient antimicrobial use and further work is required to optimise the use of antimicrobials in our hospitals.
An effective approach to improving antimicrobial use in hospitals is an organised antimicrobial management program, known as antimicrobial stewardship (AMS). Effective hospital antimicrobial stewardship programs have been shown to reduce inappropriate antimicrobial use (in the order of 22-36%), improve patient outcomes and reduce adverse consequences of antimicrobial use (including antimicrobial resistance, toxicity and unnecessary costs). Along with infection control, hand hygiene and surveillance, antimicrobial management programs are considered a key strategy in local and national programs to prevent the emergence of antimicrobial resistance and decrease preventable healthcare associated infection.
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Publications
The publication Antimicrobial Stewardship in Australian Hospitals 2011 has been produced to assist hospitals develop and implement antimicrobial stewardship (AMS) programs. The book contains 10 chapters and is divided into two parts:- Strategies for implementing and sustaining AMS; and
- Resources required for AMS.
Each chapter begins with key points and recommendations for implementing effective AMS in hospitals. Appendix 2 contains examples of templates, policies and guidelines and other educational material from Australian hospitals along with a list of useful AMS websites.
Requirements for AMS programs are defined. They include the structure and governance of AMS programs, strategies considered essential for effective AMS in Australia, and those activities that may be undertaken according to local priorities and available resources.
Antimicrobial Stewardship in Australian Hospitals can be downloaded in full or as individual chapters.
Resource materials
This section contains examples of antimicrobial stewardship resources provided by Australian hospitals. It includes committee terms of reference, policies, guidelines and educational materials.Websites
A list of websites that provide useful starting points for designing and implementing hospital stewardship programs. .Top of Page
Forums
The Antimicrobial Stewardship Forum held by the Commission in 2008. The forum was attended by representatives of states and territories, private sector, Australia and New Zealand Intensive Care Society, Royal Australasian College of Physicians, Australian Infection Control Association, Therapeutic Advisory Group, Society of Hospital Pharmacists and the Department of Health and Ageing.The objectives of the Forum were to:
- Establish level of activity in antimicrobial surveillance and containment strategies in the acute care sector (public and private) in Australia
- Agree on core components of a successful antimicrobial stewardship program – local / state / national
- Identify barriers in the development of local antibiotic stewardship programs
- Develop recommendations for a national strategy for improving the use of antimicrobials in the acute care sector.
Presentations
Members of the Antimicrobial Stewardship Advisory Committee have presented on antimicrobial stewardship at a number of forums. Copies of the presentations can be accessed below:Role of the pharmacist in antimicrobial stewardship. M Duguid November 2009 (PDF 542 KB)
Antimicrobial Stewardship Advisory Committee Update. Celia Cooper February 2010 (PDF 582 KB)
A national approach to antimicrobial stewardship. M Duguid June 2010 (PDF 736 KB)
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