Antimicrobial stewardship: attempting to preserve a strategic resource

Area of Science:

• Infectious Diseases
• Pharmacology
• Public Health

Background:

• Increasing antimicrobial resistance in gram-positive and gram-negative pathogens poses a significant threat to infection treatment.
• Suboptimal antimicrobial use is the primary driver of antimicrobial resistance, exacerbated by a lack of new antimicrobial agents.
• Antimicrobial stewardship programs (ASP) are crucial for improving antimicrobial utilization.

Purpose of the Study:

• To highlight the importance of antimicrobial stewardship programs (ASP) in addressing the challenge of antimicrobial resistance.
• To outline the goals of ASP: improving patient outcomes, minimizing toxicity, and reducing the selection of resistant strains.
• To review various strategies employed by ASPs to optimize antimicrobial use.

Main Methods:

• Restriction/pre-authorization: controlling antimicrobial orders at the time of prescription.
• Audit and feedback: reviewing ordered antimicrobials and providing recommendations for improvement.
• Supplemental strategies: education, clinical prediction rules, biomarkers, clinical decision support, and institutional guidelines.

Main Results:

• Both restriction/pre-authorization and audit/feedback strategies have proven effective in achieving stewardship goals, despite limitations.
• Supplemental strategies have also demonstrated effectiveness in improving antimicrobial use.
• The most successful ASPs integrate multiple strategies to maximize impact.

Conclusions:

• Antimicrobial stewardship programs are effective in decreasing overall antimicrobial use.
• Implementation of ASPs leads to a reduction in the spread of resistant pathogens and the incidence of Clostridioides difficile infections.
• Effective ASPs contribute to lower pharmacy costs and improved patient outcomes.