Antimicrobial stewardship programs: interventions and associated outcomes

Abstract

Guidelines regarding antimicrobial stewardship programs recommend an infectious diseases-trained physician and an infectious diseases-trained pharmacist as core members. Inclusion of clinical microbiologists, infection-control practitioners, information systems experts and hospital epidemiologists is considered optimal. Recommended stewardship interventions include prospective audit and intervention, formulary restriction, education, guideline development, clinical pathway development, antimicrobial order forms and the de-escalation of therapy. The primary outcome associated with these interventions has been the associated cost savings; however, few published investigations have taken into account the overall cost of the intervention. Over the past 5 years, there has been an increased focus upon interventions intended to decrease bacterial resistance or reduce superinfection, including infections associated with Clostridium difficile colitis. Few programs have been associated with a reduction in antimicrobial drug adverse events. Antimicrobial stewardship programs are becoming increasingly associated with clear benefits and will be integral in the in-patient healthcare setting.

Antibiotic stewardship implementation in the EU: the way forward

“…Barriers to implementing ABS programs described for the USA [27][28][29][30][31] are very similar to those experienced in European ABS programs: acquiring funding for ABS is of paramount importance. In the EU, healthcare is the responsibility of the individual member state, and there are various organizational arrangements for the delivery of care and their supporting financing and insurance systems.…”

“…The link between performance according to process of care quality indicators and clinical and resistance outcomes also needs further study. While the lack of quality research linking ABS programs with outcomes is acknowledged, it is still important to realize obvious opportunities for impacting patient outcomes, including cost-effectiveness, reduction in toxicity, and reduction in superinfection/infection due to multidrug-resistant bacteria [28].…”

Impact of Antimicrobial Stewardship Programme on Carbapenem Resistance in Gram Negative Isolates in an Indian Tertiary Care Hospital

“…It was aimed to secondarily reduce healthcare costs. As recommended by Patel et al (2008), the Antimicrobial Stewardship interventions include prospective audit and intervention, formulary restriction, education, guideline development, clinical pathway development, antimicrobial order forms and the de-escalation of therapy.…”

Impact of Stewardship Intervention on Improving Antibiotic Prescribing Practices

“…As for the elements or strategies recommended by the guidelines, they include both active and supplemental antimicrobial stewardship strategies. Antibiotic stewardship programs have been shown to have an optimistic effects on the use of antibiotic, reducing bacterial resistance, and in turn, reducing the healthcare costs [6,7]. Antibiotic stewardship should aid physicians in choosing the appropriate necessary antimicrobial agent to improve outcomes.…”