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1.5

What is AMS and why is it important?

Now we have discussed antimicrobial resistance, we will look at what an antimicrobial stewardship programme is.

Antimicrobial stewardship (AMS) is a coordinated programme that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.

Effective antimicrobial stewardship programmes can be financially self-supporting and improve patient care. Comprehensive programmes have consistently demonstrated a decrease in antimicrobial use (22%–36%), with annual savings of $200,000–$900,000 in both larger academic hospitals and smaller community hospitals.

A comprehensive, evidence-based stewardship programme to combat antimicrobial resistance includes some essential elements, such as:

1) A multidisciplinary AMS team, whose core members include:

2) Collaboration between the AMS team and the hospital infection control/pharmacy and therapeutics committees (or their equivalents).

3) The support and collaboration of hospital administration, medical staff leadership, and local providers in the development and maintenance of the programme.

4) The infectious diseases physician and the head of pharmacy, as appropriate, should negotiate with hospital administration to obtain adequate authority, compensation, and expected outcomes for the program.

5) Hospital administrative support for the necessary infrastructure to measure antimicrobial use and to track use on an ongoing basis.

6) There are two core strategies, both proactive, that provide the foundation for an antimicrobial stewardship program. These strategies are not mutually exclusive.

Prospective audit with intervention and feedback Formulary restriction and pre-authorisation
Prospective audit of antimicrobial use with direct interaction and feedback to the prescriber, performed by either an infectious diseases physician or a clinical pharmacist with infectious diseases training, can result in reduced inappropriate use of antimicrobials. Formulary restriction and pre-authorisation requirements can lead to immediate and significant reductions in antimicrobial use and cost and may be beneficial as part of a multifaceted response to a nosocomial outbreak of infection.

The following elements may be considered and prioritised as supplements:

• Education
• Guidelines and clinical pathways
• Antimicrobial cycling
• Antimicrobial order forms
• Combination therapy
• Streamlining or de-escalation of therapy
• Dose optimisation
• Parenteral to oral conversion

7) Health care information technology in the form of electronic medical records.

8) Computer-based surveillance can facilitate good stewardship by more efficient targeting of antimicrobial interventions, tracking of antimicrobial resistance patterns, and identification of nosocomial infections and adverse drug events.

9) The clinical microbiology laboratory plays a critical role in AMS by providing patient-specific culture and susceptibility data to optimise individual antimicrobial management and by assisting infection control efforts in the surveillance of resistant organisms and in the molecular epidemiologic investigation of outbreaks.

10) Both process measures (did the intervention result in the desired change in antimicrobial use?) and outcome measures (did the process implemented reduce or prevent resistance or other unintended consequences of antimicrobial use?) are useful in determining the impact of AMS on antimicrobial use and resistance patterns.

From an international perspective, antimicrobial stewardship programs (ASP) are an important step in preventing resistance and optimising patient outcomes (WHO, 2019).

Let us know in the comments below:

• Do you have an antimicrobial stewardship program currently set up in your clinical setting?