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 (AMS) 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.
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.
The health service organisation implements systems for the safe and appropriate prescribing and use of antimicrobials as part of an antimicrobial stewardship program.
Since January 2013 health services have been 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. Assessment to the second edition will commence from 1 January 2019.
The Preventing and Controlling Healthcare-Associated Infections Standard includes actions on the following.
All healthcare services are required to have an antimicrobial stewardship program that:
This publication provides clinicians and health administrators with the evidence and requirements for hospital antimicrobial stewardship (AMS) programs.
It is available to download in full, or by chapter. The publication summarises current evidence about AMS strategies and interventions and their implementation
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 at
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.
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 (NAPS) and the National Antimicrobial Utilisation Surveillance Program (NAUSP).
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.
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.