Antimicrobial stewardship
Section snippets
Conceptual framework for antibiotic use
Antibiotic resistance is a multifaceted problem requiring multifactorial interventions to prevent its emergence and further spread. As schematically illustrated in Fig 2, these factors include strategies to reduce reservoirs of resistant bacteria, improved diagnostics to identify the etiology of infections and help direct therapy, development of new antibiotics and vaccines, improved use of current vaccines, infection-control measures to prevent transmission of resistant species (particularly
Strategies to improve antibiotic use
Several interventions promote the judicious use of antibacterial agents including education, formulary restriction, prior approval, streamlining, antibiotic cycling, and computer-assisted programs.
Comprehensive control: The Hospital of the University of Pennsylvania program as a paradigm
Healthcare institutions often combine a number of the above-mentioned individual strategies to create a more comprehensive program for antimicrobial management and resistance control (Fig 3).12, 13 Because these programs involve multiple factors or individual strategies and typically entail collaboration between different groups within and sometimes outside of the institution, they are often referred to as multifaceted and multidisciplinary programs. Computer-assisted software programs
Can antibacterial stewardship limit emergence of resistance?
Unfortunately, studies in this area are somewhat sparse, and available reports may have study-design shortcomings such as selection bias, insufficient power, inadequate preobservation and postobservation datum points, and failure to deal with confounders. Of equal importance, antibiotic stewardship programs are generally implemented at a time of crisis, e.g., in response to emergence of resistance in a given institution or ward. Because multiple interventions are typically implemented
Summary
The antibiotic armamentarium is decreasing due to increasing emergence of bacteria resistant to currently available agents, coupled with a dwindling pipeline for new drugs. New agents are urgently needed, but as noted by Dennis Maki in 1998 at the annual meeting of the IDSA, “The development of new antibiotics without having mechanisms to insure their appropriate use is much like supplying your alcoholic patients with a finer brandy.” Antibiotic stewardship should extend the effectiveness of
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