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The management of antimicrobial resistance requires four elements:

• Comprehensive antimicrobial resistance and usage surveillance programs
• Strategies to improve the use of antimicrobial agents (antimicrobial stewardship programs)
• Effective infection control programs to minimise secondary spread of resistance
• Development of new drugs and vaccines

Comprehensive antimicrobial resistance and usage surveillance programs are necessary to inform antimicrobial stewardship strategies and measure their effect. A comprehensive infection control program is necessary to maintain the benefits of antimicrobial stewardship strategies.

Antimicrobial stewardship has been defined as ‘an ongoing effort by a health-care institution to optimise antimicrobial use among hospital patients in order to improve patient outcomes, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use (including antimicrobial resistance)’. Stewardship programs aim to effect change in antimicrobial prescribing, reducing unnecessary use and promoting the use of agents less likely to select resistant bacteria. in line with guidelines and demonstrated incidence of antimicrobial resistance (as shown by antibiograms, an antibiogram being the result of laboratory testing on an isolated pathogen to determine which antimicrobials the pathogen is resistant to). Successful programs have been shown to reduce institutional resistance rates as well as morbidity, mortality and cost.

Publications

The Antimicrobial Stewardship Advisory Committee is currently working on a publication - Antimicrobial stewardship in Australian Hospitals. The publication provides guidance on developing and introducing a hospital antimicrobial stewardship program. It describes the structure and governance required and the resources needed for an effective program, along with those strategies shown to influence antimicrobial prescribing and inappropriate use. (Copies will be available in the second half of 2010 from the website's publication page).

The publication was one of the outcomes of 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:

1. Establish level of activity in antimicrobial surveillance and containment strategies in the acute care sector (public and private) in Australia
2. Agree on core components of a successful antimicrobial stewardship program – local / state / national
3. Identify barriers in the development of local antibiotic stewardship programs
4. 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)

Updated: 21 July, 2010

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