Antimicrobial Stewardship

Antimicrobial stewardship promotes optimal antimicrobial prescribing. The aim of the Commission’s work on antimicrobial stewardship  is to improve the safe and appropriate use of antimicrobials, reduce patient harm and decrease the incidence of antimicrobial resistance in Australian hospitals.

Inappropriate and over use of antimicrobials contributes to the emergence of resistant bacteria and causes patient harm. Patients with antimicrobial-resistant infections are more likely to experience ineffective treatment, recurrent infection, delayed recovery or even death.

Antimicrobial stewardship programs have been shown to decrease inappropriate antimicrobial usage, improve patient outcomes and reduce adverse consequences of antimicrobial use (including antimicrobial resistance, toxicity and unnecessary costs). Along with infection prevention and control, hand hygiene and surveillance, antimicrobial stewardship is considered a key strategy in local and national programs to prevent the emergence of antimicrobial resistance and decrease preventable healthcare associated infection.

Preventing and Controlling Healthcare-Associated Infection Standard

The Antimicrobial Stewardship criterion of the Standard requires health service organisations to implement systems for the safe and appropriate prescribing and use of antimicrobials as part of an antimicrobial stewardship program.

Health services are required to demonstrate they are meeting the requirements outlined in the NSQHS Standards in order to achieve accreditation. A range of resources is available to assist health services to implement each Standard.  

The Preventing and Controlling Healthcare-Associated Infections Standard requires all health service organisations to have an AMS program that:

  • Includes an antimicrobial stewardship policy
  • Provides access to, and promotes the use of, current evidence-based Australian therapeutic guidelines and resources on antimicrobial prescribing
  • Has an antimicrobial formulary that includes restriction rules and approval processes
  • Incorporates core elements, recommendations and principles from the current Antimicrobial Stewardship Clinical Care Standard
  • Reviews antimicrobial prescribing and use
  • Uses surveillance data on antimicrobial resistance and use to support appropriate prescribing
  • Evaluates performance of the program, identify areas for improvement, and take action to improve the appropriateness of antimicrobial prescribing and use
  • Reports to clinicians and the governing body regarding
    • compliance with the antimicrobial stewardship policy
    • antimicrobial use and resistance
    • appropriateness of prescribing and compliance with current evidence-based Australian therapeutic guidelines or resources on antimicrobial prescribing

Antimicrobial Stewardship in Australian Health Care 2018

This publication provides clinicians and health administrators with the evidence and requirements for hospital antimicrobial stewardship (AMS) programs. The publication summarises current evidence about AMS strategies and interventions and their implementation.

Antimicrobial Prescribing E-learning Modules

The Commission and NPS MedicineWise have developed a series of e-learning modules on antimicrobial prescribing.

The modules are aimed at prescribers in their first 2 years out of medical school, as well as nurse practitioners, hospital pharmacists and university students. The modules address specific areas where antimicrobial use in hospitals is suboptimal. The modules can be accessed on the NPS MedicineWise website

Antimicrobial Stewardship Video Presentations

Miss Caroline Chen (Principles of antibiotic pharmacotherapy) outlines different classes of commonly used antibiotics, their spectrum of activity and issues to consider when prescribing and administering these commonly used agents.

Surveillance of Antimicrobial Use

The Commission has established the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System to coordinate data on antimicrobial use and resistance in Australia. The surveillance programs that contribute antimicrobial use data to AURA are the National Antimicrobial Prescribing Survey and the National Antimicrobial Utilisation Surveillance Program.  

National Antimicrobial Prescribing Survey (NAPS)

NAPS is a voluntary audit of antimicrobial use that provides a snapshot of appropriateness of antimicrobial prescribing, and compliance with guidelines in Australian hospitals.

Monitoring the appropriateness of antimicrobial prescribing should be the ultimate aim of any AMS program. Data from prescribing surveys can be used to monitor effectiveness of interventions and establish priorities for improvement. To coincide with  Antibiotic Awareness Week 2013 the Melbourne Health NH&MRC Antimicrobial Stewardship research team coordinated the National Antimicrobial Prescribing Survey (NAPS). This work was supported by the Commission. Registration to the NAPS remains open.  

National Antimicrobial Utilisation Surveillance Program (NAUSP)

NAUSP is a voluntary program that captures standardised data on the volume of antimicrobial usage measured in defined daily doses (DDDs)/1,000 occupied bed days (OBDs) in Australian hospitals.

Monitoring usage and resistance is important for measuring the effects of stewardship interventions and understanding local antimicrobial resistance patterns, and are key requirements of an AMS program.