Antimicrobial stewardship program: Difference between revisions
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== Core Elements == |
== Core Elements == |
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| + | === Hospital Leadership Commitment === |
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| − | * Senior hospital management leadership towards antimicrobial stewardship |
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| + | * Need support from senior leadership, including chief medical officer, chief nursing officer, and director of pharmacy |
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| + | * Need leaders to give time to manage the program, resource (including staffing) |
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* Accountability and responsibilities |
* Accountability and responsibilities |
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* Available expertise on infection management |
* Available expertise on infection management |
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Revision as of 13:03, 10 August 2022
Background
- Program to ensure that antimicrobials are used appropriately, in order to improve patient outcomes
Core Elements
Hospital Leadership Commitment
- Need support from senior leadership, including chief medical officer, chief nursing officer, and director of pharmacy
- Need leaders to give time to manage the program, resource (including staffing)
- Accountability and responsibilities
- Available expertise on infection management
- Education and practical training
- Other actions aiming at responsible antimicrobial use
- Monitoring and surveillance
- Reporting and feedback
Possible Interventions
- Preauthorization
- Prospective audit and feedback
- Didactic educational activities, including lectures and pamphlets
- Facility-specific clinical practice guidelines for common syndromes
- Reducing use of antibiotics with increased risk of C. difficile infection
- Prescriber-led review, including antibiotics time-outs and stop orders
- Computerized clinical decision-making support at the time of prescribing
- PK monitoring and adjustment of aminoglycosides and vancomycin
- Alternative dosing of β-lactams
- Interventions to increase the use of oral antibiotics for initial therapy as well as timely transition from IV to oral antibiotics
- Interventions to reduce the duration of antibiotics to shortest effective duration
- Allergy assessments and penicillin skin testing for patients with reported β-lactam allergy
- Development of stratified antibiograms (e.g. by location or age)
- Selective and cascade reporting of antimicrobial susceptibility
- Rapid viral testing for respiratory pathogens to reduce the use of inappropriate antibiotics
- Rapid diagnostic testing on blood specimens
- Serial procalcitonin in ICU patients
Recommended Against
- Cycling antibiotics
Further Reading
- How to start an antimicrobial stewardship programme in a hospital. Clin Microbiol Infect. 2019;26(4):447-453. doi: 10.1016/j.cmi.2019.08.007
- Implementing an Antibiotic Stewardship Program: Guidelines by the IDSA and the SHEA. Clin Infect Dis. 2016;62(10):e51-e77. doi: 10.1093/cid/ciw118
- IDSA and the SHEA Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clin Infect Dis. 2007;44:159-77. doi: 10.1086/510393
