Antimicrobial formularies: can they minimize antimicrobial resistance?

Area of Science:

• Infectious Diseases
• Microbiology
• Health Management

Background:

• Antimicrobial resistance (AMR) is a growing global health threat.
• Strategies to control AMR, such as restricting antimicrobial drug use, have had complex outcomes, sometimes leading to increased resistance in other microorganisms.
• The relationship between antimicrobial drug usage patterns and resistance rates is not fully understood, impacting the effectiveness of antimicrobial stewardship programs.

Purpose of the Study:

• To describe the relationship between antimicrobial drug use and resistance rates.
• To explore the implications of these relationships for antimicrobial formularies.
• To evaluate the feasibility of optimizing antimicrobial drug diversity to minimize resistance.

Main Methods:

• Analysis of antimicrobial drug use and resistance data from a network of 40 hospitals.
• Examination of the correlation between the type and volume of antimicrobial agents used and observed resistance rates.
• Review of the potential impact of antimicrobial formulary adjustments on resistance patterns.

Main Results:

• Significant variability in antimicrobial drug use was observed across the participating hospitals.
• The specific types and quantities of antimicrobial agents utilized were found to be key determinants of resistance rates.
• Efforts to restrict certain antimicrobial drugs led to increased resistance in other microbial populations.

Conclusions:

• Antimicrobial resistance is influenced by the specific types and volumes of drugs used.
• Random cycling of antimicrobial agents has been proposed but requires further validation.
• Judicious modifications to antimicrobial formularies may offer a feasible strategy to optimize drug use diversity and mitigate antimicrobial resistance.