Tackling antimicrobial resistance issues

The incidence of antibiotic-resistant strains continues to rise rapidly, making the need to combat antimicrobial resistance a global concern. For local, regional and national healthcare organisations, the ability to manage this resistance effectively starts with the introduction of an antimicrobial stewardship programme (ASP). ASPs have been proven to lower antimicrobial resistance, establishing a solid return on investment (ROI) for healthcare organisations by reducing drug-related adverse events, improving clinical outcomes and shrinking healthcare costs. By effectively setting parameters around the dose, frequency and route of administration of antimicrobials and monitoring use through both electronic and human interventions, the potential for adverse drug events (ADEs) is minimised as well as the disproportionate costs associated with them. It is an investment of resources that many healthcare experts believe is well justified for both the hospital and patient. Consider a recent initiative at a large academic medical centre targeting two antimicrobials. The end-result produced a 37% reduction in days of unnecessary therapy. Another initiative at a mediumsized hospital realised a 22% decrease in use of parenteral broad-spectrum antimicrobial use. A number of factors have been identified as contributors to the development of antimicrobial resistance. Specifically, changes in the frequency of antimicrobial use are directly related to changes in resistance, with higher rates resulting in higher incidence of resistance. A correlation has also been established between patients with healthcare-acquired infections (HAIs) and prior antimicrobial use, further confirming the association between use and resistance. In addition, the duration of antimicrobial exposure has been directly linked with the likelihood of resistant organism colonisation. To counter the increased risk of resistance and potential for popular antibiotics losing their effectiveness, a growing number of healthcare organisations are establishing ASPs for constant monitoring of antimicrobial use in an effort to limit the emergence and spread of resistant pathogens. The most successful of these initiatives feature a combination of solid clinical decision support technology and strategies for managing use, education and clinical pathways.

Goals of an ASP

Optimisation of antimicrobial use is the overriding goal of any ASP. Ultimately, it is about finding the balance between effective use and overuse – equating to managing proper selection, duration, dose, and route of administration. This process should aim to enhance clinical outcomes by improving the efficacy of identified drugs and lowering the risk of unintentional consequences associated with antimicrobial use. In tandem with improved patient care, the programme should result in cost efficiencies associated with decreased use of antimicrobials, minimised ADEs and appropriate length of stay (LOS). To successfully achieve these aims, an ASP should include methods for: • Tracking and reducing antimicrobial resistance. • Encouraging appropriate treatment patterns. • Collaboration between physicians, pharmacy, laboratory personnel and infection preventionists with best patient outcome in mind. • Ongoing and formalised education of staff and providers.