Antimicrobial Stewardship Programs as a Means to Optuimize Anitmicrobial Use

Robert C. Owens, Jr., Pharm.D.; Gilles L. Fraser, Pharm.D., FCCM; Patricia Stogsdill, MD

Disclosures

Pharmacotherapy. 2004;24(7) 

In This Article

Abstract and Introduction

Abstract

Each year, approximately 2 million people in the United States contract an infection during a hospital stay. An increasing percentage of these institutionally acquired infections are attributed to antimicrobial-resistant organisms. At the same time, studies and surveys suggest that as much as half of all antimicrobial use is inappropriate. Recommendations for preventing and reducing antimicrobial resistance in hospitals stress the importance of improving antimicrobial use, referred to as antimicrobial stewardship, at the institutional level. Antimicrobial stewardship programs have served as wake-up calls to both clinicians and health care administrators. We review the more recent literature concerning the impact of antimicrobial stewardship programs on costs, outcomes, and resistance and summarize important considerations for implementation of these programs.

Introduction

Institutionally acquired infections affect approximately 2 million people in the United States annually.[1] An increasing percentage of these infections are attributed to antimicrobial-resistant organisms.[2] Twenty-five million pounds of antibiotics are produced each year for human consumption and are administered to 30-50% of hospitalized patients; nonhospitalized patients receive 160 million courses.[3] All the while, studies and surveys suggest that as much as 50% of all antimicrobial use is inappropriate.[4]

Recognizing the importance of drug-resistant organisms, the Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America in 1997 published recommendations for preventing and reducing antimicrobial resistance in hospitals.[5] In 1999, the Interagency Task Force on Antimicrobial Resistance -- cochaired by the Centers of Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health -- assembled a more global document addressing the threat of increasing resistance.[6] Both documents stress the importance of improving the use of antimicrobials, or antimicrobial steward-ship, at the institutional level in combating antimicrobial resistance. The documents have been successful in serving as wake-up calls to clinicians and health care administrators alike.

The term antimicrobial stewardship is defined as the optimal selection, dosage, and duration of antimicrobial treatment that results in the best clinical outcome for the treatment or prevention of infection, with minimal toxicity to the patient and minimal impact on subsequent resistance.[4] Multidisciplinary programmatic efforts to optimize antimicrobial use in both large and small hospitals have led to measurable ecologic and economic benefits.

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