An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appropriate drugs, determination of administration routes and standardization of both medication dosage and treatment duration. The program involves, but is not limited to, Hospital Staff Education, Pharmacodynamics Dose Optimization, Computer-Assisted Decision Support Programs, Pharmacist-Driven Intravenous to Oral Switch Programs, Pharmacy Dosing Programs and Antibiotic Cycling. A study was conducted to determine effectiveness of the ASP in significantly improving patient outcomes (e.g. decrease morbidity and mortality from infection). This was undertaken by collecting restrospective data on patient length of hospital stay, bed turnover rate and antibiotic consumption over a period of 2 years since the ASP was initiated. Periodic data were then compared and interpreted based on its clinical, quality and financial implications in order to measure effectiveness of the program implementation.
References
[1]
Gould, I.M. and Bal, A.M. (2013) New Antibiotic Agents in the Pipeline and How They Can Help Overcome Microbial Resistance. Virulence, 4, 185-191.
https://doi.org/10.4161/viru.22507
[2]
Piddock, L.J.V. (2012) The Crisis of No New Antibiotics—What Is the Way Forward? The Lancet Infectious Diseases, 12, 249-253.
https://doi.org/10.1016/S1473-3099(11)70316-4
[3]
Rossolini, G.M., Arena, F., Pecile, P. and Pollini, S. (2014) Update on the Antibiotic Resistance Crisis. Current Opinion in Pharmacology, 18, 56-60.
https://doi.org/10.1016/j.coph.2014.09.006
[4]
Spellberg, B. and Gilbert, D.N. (2014) The Future of Antibiotics and Resistance: A Tribute to a Career of Leadership by John Bartlett. Clinical Infectious Diseases, 59, S71-S75. https://doi.org/10.1093/cid/ciu392
[5]
Sengupta, S., Chattopadhyay, M.K. and Grossart, H.-P. (2013) The Multifaceted Roles of Antibiotics and Antibiotic Resistance in Nature. Frontiers in Microbiology, 4, 47. https://doi.org/10.3389/fmicb.2013.00047
[6]
Kumarasamy, K.K., Toleman, M.A., Walsh, T.R., Bagaria, J., Butt, F., Balakrishnan, R., Chaudhary, U., Doumith, M., Giske, C.G. and Irfan, S. (2010) Emergence of a New Antibiotic Resistance Mechanism in India, Pakistan, and the UK: A Molecular, Biological, and Epidemiological Study. The Lancet Infectious Diseases, 10, 597-602.
https://doi.org/10.1016/S1473-3099(10)70143-2
[7]
Cosgrove, S.E., Kaye, K.S., Eliopoulous, G.M. and Carmeli, Y. (2002) Health and Economic Outcomes of the Emergence of Third-Generation Cephalosporin Resistance in Enterobacter Species. Archives of Internal Medicine, 162, 185-190.
https://doi.org/10.1001/archinte.162.2.185
[8]
This Week (2013) The Antibiotic Alarm. Nature, 495, 141.
https://doi.org/10.1038/495141a
[9]
Gonzales, R., Malone, D.C., Maselli, J.H. and Sande, M.A. (2001) Excessive Antibiotic Use for Acute Respiratory Infections in the United States. Clinical Infectious Diseases, 33, 757-762. https://doi.org/10.1086/322627
[10]
Marr, J.J., Moffet, H.L. and Kunin, C.M. (1988) From the Infectious Diseases Society of America Guidelines for Improving the Use of Antimicrobial Agents in Hospitals: A Statement by the Infectious Diseases Society of America. The Journal of Infectious Diseases, 157, 869-876. https://doi.org/10.1093/infdis/157.5.869
[11]
Van Boeckel, T.P., Gandra, S., Ashok, A., Caudron, Q., Grenfell, B.T., Levin, S.A. and Laxminarayan, R. (2014) Global Antibiotic Consumption 2000 to 2010: An Analysis of National Pharmaceutical Sales Data. The Lancet Infectious Diseases, 14, 742-750. https://doi.org/10.1016/S1473-3099(14)70780-7
[12]
Ventola, C.L. (2015) The Antibiotic Resistance Crisis: Part 1: Causes and Threats. P & T: A Peer-Reviewed. Journal for Formulary Management, 40, 277-283.
[13]
Lesprit, P. and Brun-Buisson, C. (2008) Hospital Antibiotic Stewardship. Current Opinion in Infectious Diseases, 21, 344-349.
https://doi.org/10.1097/QCO.0b013e3283013959
[14]
Fishman, N. (2006) Antimicrobial Stewardship. American Journal of Infection Control, 34, S55-S63. https://doi.org/10.1016/j.ajic.2006.05.237
[15]
Dik, J.-W.H., Vemer,P., Friedrich, A.W., Hendrix, R., Lo-Ten-Foe, J.R., Sinha, B. and Postma, M.J. (2015) Financial Evaluations of Antibiotic Stewardship Programs—A Systematic Review. Frontiers in Microbiology, 6, 317.
https://doi.org/10.3389/fmicb.2015.00317
[16]
Baur, D., Gladstone, B.P., Burkert, F., Carrara, E., Foschi, F., Döbele, S. and Tacconelli, E. (2017) Effect of Antibiotic Stewardship on the Incidence of Infection and Colonisation with Antibiotic-Resistant Bacteria and Clostridium Difficile Infection: A Systematic Review and Meta-Analysis. The Lancet Infectious Diseases, 17, 990-1001. https://doi.org/10.1016/S1473-3099(17)30325-0
[17]
Paskovaty, A., Pflomm, J.M., Myke, N. and Seo, S.K. (2005) A Multidisciplinary Approach to Antimicrobial Stewardship: Evolution into the 21st Century. International Journal of Antimicrobial Agents, 25, 1-10.
https://doi.org/10.1016/j.ijantimicag.2004.09.001
[18]
Rzewuska, M., Charani, E., Clarkson, J.E., Davey, P.G., Duncan, E.M., Francis, J.J., Gillies, K., Kern, W.V., Lorencatto, F., Marwick, C.A., McEwen, J., Möhler, R., Morris, A.M., Ramsay, C.R., Rogers Van Katwyk, S., Skodvin, B., Smith, I., Suh, K.N. and Grimshaw, J.M. (2019) Prioritizing Research Areas for Antibiotic Stewardship Programmes in Hospitals: A Behavioural Perspective Consensus Paper. Clinical Microbiology and Infection, 25, 163-168.
https://doi.org/10.1016/j.cmi.2018.08.020
[19]
Doron, S. and Davidson, L.E. (2011) Antimicrobial Stewardship. Mayo Clinic Proceedings, 86, 1113-1123. https://doi.org/10.4065/mcp.2011.0358
[20]
Seligman, S.J. (1981) Reduction in Antibiotic Costs by Restricting Use of an Oral Cephalosporin. The American Journal of Medicine, 71, 941-944.
https://doi.org/10.1016/0002-9343(81)90304-1
[21]
Hayman, J.N. and Sbravati, E.C. (1985) Controlling Cephalosporin and Aminoglycoside Costs through Pharmacy and Therapeutics Committee Restrictions. American Journal of Health-System Pharmacy, 42, 1343-1347.
https://doi.org/10.1093/ajhp/42.6.1343
[22]
Fraser, G.L., Stogsdill, P., Dickens Jr., J.D., Wennberg, D.E., Smith Jr., R.P. and Prato, B.S. (1997) Antibiotic Optimization: An Evaluation of Patient Safety and Economic Outcomes. JAMA Internal Medicine, 157, 1689-1694.
https://doi.org/10.1001/archinte.1997.00440360105012
[23]
Solomon, D.H., Van Houten, L., Glynn, R.J., Baden, L., Curtis, K., Schrager, H. and Avorn, J. (2001) Academic Detailing to Improve Use of Broad-Spectrum Antibiotics at an Academic Medical Center. JAMA Internal Medicine, 161, 1897-1902.
https://doi.org/10.1001/archinte.161.15.1897
[24]
Paramythiotou, E., Lucet, J.-C., Timsit, J.-F., Vanjak, D., Paugam-Burtz, C., Trouillet, J.-L., Belloc, S., Kassis, N., Karabinis, A. and Andremont, A. (2004) Acquisition of Multidrug-Resistant Pseudomonas Aeruginosa in Patients in Intensive Care Units: Role of Antibiotics with Antipseudomonal Activity. Clinical Infectious Diseases, 38, 670-677. https://doi.org/10.1086/381550
[25]
Finkelstein, J.A., Davis, R.L., Dowell, S.F., Metlay, J.P., Soumerai, S.B., Rifas-Shiman, S.L., Higham, M., Miller, Z., Miroshnik, I., Pedan, A. and Platt, R. (2001) Reducing Antibiotic Use in Children: A Randomized Trial in 12 Practices. Pediatrics, 108, 1-7.
https://doi.org/10.1542/peds.108.1.1
[26]
Venekamp, R.P., Sanders, S.L., Glasziou, P.P., Del Mar, C.B. and Rovers, M.M. (2015) Antibiotics for Acute Otitis Media in Children. Cochrane Database of Systematic Reviews, No. 6. https://doi.org/10.1002/14651858.CD000219.pub4
[27]
Chiu, C.-H., Su, L.-H., Huang, Y.-C., Lai, J.-C., Chen, H.-L., Wu, T.-L. and Lin, T.-Y. (2007) Increasing Ceftriaxone Resistance and Multiple Alterations of Penicillin-Binding Proteins among Penicillin-Resistant & Streptococcus Pneumoniae & Isolates in Taiwan. Antimicrobial Agents and Chemotherapy, 51, 3404.
https://doi.org/10.1128/AAC.01563-06
[28]
Jang, W.H., Yoo, D.H. and Park, S.W. (2011) Prevalence of and Risk Factors for Levofloxacin-Resistant E. coli Isolated from Outpatients with Urinary Tract Infection. Korean Journal of Urology, 52, 554-559.
https://doi.org/10.4111/kju.2011.52.8.554
[29]
Smith, A. (2018) Metronidazole Resistance: A Hidden Epidemic? British Dental Journal, 224, 403-404. https://doi.org/10.1038/sj.bdj.2018.221
