كتاب
Implementing an Antimicrobial Stewardship Program
- Executive Summary
Antimicrobial stewardship programs (ASPs) are a focused effort by a health care system to optimize the use of antimicrobial agents. The goals of an ASP are to improve patient outcomes, decrease adverse consequences including from adverse drug reactions and antimicrobial associated infections (eg, Clostridium difficile diarrhea), reduce or prevent antimicrobial resistance, and deliver cost-effective therapy. The emphasis is on appropriate use, selection, dosing, and duration of antimicrobial therapy.
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Recommendations |
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1. Program structure & governance |
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AMS team should include a microbiologist, an info-systems specialist, an infection control professional, and a hospital epidemiologist (Strong Recommendation). |
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Maintain close collaboration among AMS team, Microbiology, Pharmacy, and Infection and Prevention Control (IPC) departments (Strong Recommendation) |
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Implement an antimicrobial stewardship program as part of MDRO prevention (Good Practice Statement) |
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Ensure enabling infrastructure: IT that supports alerts and data capture; adequate lab support; leadership (Good Practice Statement) |
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2. Core AMS interventions |
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Perform regular prospective audits with direct feedback to prescribers and administration to reduce inappropriate antibiotic use (Strong Recommendation) |
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Enforce formulary restriction & preauthorization to reduce antimicrobial use (Strong Recommendation) |
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Educate all stakeholders to build foundational knowledge (Good Practice Statement) |
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Clinical pharmacy interventions should be implemented (Good Practice Statement) |
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Avoid antimicrobial cycling (Good Practice Statement) |
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3. Prescribing & optimization practices |
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De-escalate empiric therapy once culture/susceptibility results are available (Strong Recommendation) |
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Audit and education on de-escalation should be part of AMS (Strong Recommendation) |
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We recommend early switch from IV to PO where clinically appropriate - cost-saving and desirable, especially in resource-limited settings (Strong Recommendation) |
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We recommend against routine combination therapy to prevent resistance (Good Practice Statement). |
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Avoid treating colonization or contaminants (Good Practice Statement). |
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4. Microbiology & surveillance enablers |
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Provide MDRO data/outcomes to stakeholders to maintain engagement (Good Practice Statement). |
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Educate healthcare personnel about MDRO and prevention practices (Good Practice Statement). |
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Educate patients and families about MDRO (Good Practice Statement). |
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Incorporate lab-based MRSA alerts and readmission alerts to inform AMS and IPC teams (Good Practice Statement). |
