Antimicrobial Stewardship

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 change antimicrobial prescribing to reduce unnecessary use and promote 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 find out what antimicrobials the pathogen is resistant to). Successful programs have been shown to reduce institutional resistance rates as well as morbidity, mortality and cost.

A Forum was held on 11 September 2008 to:

1. Establish level of activity in antimicrobial surveillance and containment strategies in 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 to develop local antibiotic stewardship programs


4. Develop recommendations for a national strategy for improving the use of antimicrobials in the acute care sector.

The Antimicrobial Stewardship Committee has completed a review of the literature around strategies for Antimicrobial Stewardship. These reviews appear in the links below.

1. Persuasive / Educational
   
   1. Education of prescribers, including the impact of the pharmaceutical industry (PDF 43 KB)
2. Restrictive



Pre prescription


2. Formulary restriction, antimicrobial cycling and antimicrobial approval systems (PDF 45 KB)


Post prescription

3. Review of antimicrobial use with direct interaction and feedback to the prescriber (PDF 30 KB)


4. Point of care interventions (PDF 45 KB)


1. Directed antimicrobial therapy on the basis of culture results


2. Dose optimization


3. Parenteral to oral conversion

Resources

1. Personnel


5. Effective institutional antimicrobial stewardship teams (including governance) (PDF 80 KB)


6. Role of clinical microbiologists and laboratory (PDF 216 KB)


1. Antibiograms


2. Selective reporting
7. Role of infectious diseases physicians (local policy development)


8. Role of pharmacists (PDF 54 KB)
2. Tools


9. Integration of stewardship programs into electronic decision support systems and new technology platforms (PDF 46 KB)

Evaluation, Audit and feedback

10. Effective use of collective surveillance data (PDF 324 KB)

Updated: 14 December, 2009

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