Antibiotics and Adverse Events

The Role of Antimicrobial Stewardship Programs in 'Doing No Harm'

Karri A. Bauer; Ravina Kullar; Mark Gilchrist; Thomas M. File Jr.

Disclosures

Curr Opin Infect Dis. 2019;32(6):553-558. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Antimicrobial resistance (AMR) is a global threat worldwide, with deaths associated with AMR infections projected to exceed 10 million per year by the year 2050. The overuse and misuse of antibiotics is the primary driver of this resistance, with up to 50% of antibiotics prescribed in the hospital setting being either unnecessary or inappropriate. Antimicrobial stewardship (AMS) programs (ASPs) can mitigate some of this resistance, with the benefits well recognized; however, if we are to truly advance the state of AMS, the principles and practices should align with patient safety.

Recent findings: In a recent evaluation, among 1488 adult patients receiving systemic antibiotic therapy, 298 (20%) experienced at least one antibiotic-associated adverse drug event (ADE). Fifty-six (20%) nonclinically indicated antibiotic regimens were associated with an ADE. It is also well recognized that besides ADEs, the inappropriate use of antibiotics is associated the development of multidrug-resistant infections and Clostridium difficile infection.

Summary: Currently, there is a significant gap in ASPs correlating initiatives with patient safety goals, including reductions in antibiotic-associated ADEs and multidrug-resistant infections. Therefore, in this article, we provide the rationale for why ASPs are best suited to lead a collaborative effort to prevent antibiotic-associated ADEs and multidrug-resistant infections.

Introduction

The globalization of antimicrobial stewardship (AMS) programs (ASPs) is necessary in the fight against antimicrobial resistance (AMR) with deaths attributed to resistant infections projected to exceed 10 million/year by 2050.[1] All antibiotic use, of which approximately 50% is overuse and misuse, is the primary driver of antibiotic resistance.[2,3] The United Nations issued a call to action for countries to implement AMS to address AMR and overuse of antibiotics. While the benefits of AMS in the healthcare environment have received increasing recognition, there remains an opportunity to enhance the importance of ASPs by focusing on patient safety.

AMS has emerged as one of the key strategies employed to minimize the development of resistance to preserve antibiotic efficacy considering dwindling candidates in the pipeline. However, there are significant challenges in assessing the achievements of ASPs globally as data are limited, and the level of interventions is variable. Currently, most ASPs' efforts have focused on optimized antibiotic use, improved clinical and microbiological outcomes in hospital settings, and reduced antibiotic costs.[4–6] However, if we are to truly advance the state of AMS, efforts should focus on principles and practices that align with patient safety, including reductions in antibiotic-associated adverse drug events (ADEs) and multidrug-resistant infections. Therefore, in this article we provide the rationale for why ASPs' efforts should also focus on patient safety by leading collaborative efforts to prevent antibiotic-associated ADEs and multidrug-resistant infections.

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