Antimicrobial resistance (AMR)has been labelled one of the greatest threats to human health today. Antimicrobial refers to a group of agents that are used to treat a range of microbes, including bacteria, fungi, parasites and viruses. Antibiotics are one group of antimicrobial used specifically to kill bacteria. During Antibiotic Awareness Week, there is a focus on addressing inappropriate antibiotic use, as these drugs are the most commonly used antimicrobial agents in healthcare.
Resistance to antibiotics is commonly found in Australian hospitals and increasingly in the community. The prevalence of multidrug-resistant bacterial pathogens is rising. Patients with infections due to resistant bacteria experience delayed recovery and treatment failure and are at least twice as likely to die as patients with infections from non-resistant organisms.
Inappropriate and over use of antibiotics is a major driver of antibiotic resistance. Inappropriate use also increases the risk of harm to patients from avoidable adverse reactions, interactions with other drugs and Clostridium difficile infection. Results from the 2014 National Antimicrobial Prescribing Survey (NAPS) show that up to one quarter of antimicrobial regimens prescribed in Australian hospitals are considered inappropriate. Compared with northern Europe, Australian hospitals have a higher overall rate of inpatient antimicrobial use.
As antibiotic resistance is increasing the development of new antibiotic agents is declining. Few new antibiotic agents have been developed in recent years. This means that many of the medical advances taken for granted such as cancer treatment, transplantation, surgery and neonatal care that rely on antibiotics to control infection are becoming endangered.
The challenge for Australian hospitals is to reduce inappropriate and over use of antibiotics and indeed all antimicrobials. This can be achieved through antimicrobial stewardship (AMS). The aim of AMS is to reduce unnecessary use of antimicrobials, optimize their use, and promote those antimicrobials less likely to select resistant bacteria. Successful AMS programs contain a range of strategies and require the necessary structure and governance to support their implementation and sustainability. They are part of a broader system for infection prevention and control to minimise resistance.
Reference and further reading: Duguid M, Cruickshank M (editors). Antimicrobial Stewardship in Australian Hospitals. Sydney: Australian Commission on Safety and Quality in Health Care, 2011.
The Commission coordinates and leads a number of programs relevant to addressing antibiotic resistance:
The Commission has been engaged by the Department of Health to coordinate the development of a national antimicrobial resistance surveillance system as a significant platform for reducing the impact of antimicrobial resistance.
The HAI Prevention Program aims to build on facility and jurisdictional initiatives to develop a national approach to reducing HAI by identifying and addressing systemic problems and gaps, and ensuring comprehensive actions are undertaken in a nationally coordinated way by leaders and decision makers in both public and private health care sectors. The National Antimicrobial Stewardship Initiative is a key component of the HAI program and aims to support activities that optimise antimicrobial use, improve patient outcomes and reduce the incidence of antimicrobial resistance in Australian hospitals.
The Antimicrobial Stewardship (AMS) Clinical Care Standard aims to ensure that a patient with a bacterial infection receives optimal treatment with antibiotics – the right antibiotic to treat their condition, the right dose, by the right route, at the right time and for the right duration based on accurate assessment and timely review.