Earlier this year, the Obama Administration announced a 5-year plan to combat antibiotic resistance. The Forum on Antibiotic Stewardship was created to meet this "growing public health threat" and to reduce the misuse of antibiotics.
Earlier this year, President Obama announced the Administration’s 5-year plan to combat antibiotic resistance and called it a “growing public health threat.”
The Forum on Antibiotic Stewardship was created to reduce antibiotic resistance. The Forum and stakeholders called for stewardship to optimize antibiotic use in both humans and animals, and to reduce the misuse of antibiotics driving the development of resistance.
“Antibiotic stewardship . . . can only be achieved through the use of effective tools, coupled with motivated and trained individuals to form a strategy,” said Mark Miller, MD, FRCPC, chief medical officer of bioMérieux, one of the Forum participants. “The tools and people required to effectively achieve antibiotic stewardship differ according to the situation and the resources needed. Achieving the objective of antibiotic stewardship when raising food animals employs different tools, people and strategies than those employed in a hospital stewardship program.”
Yet the objective is the same: Appropriate use of antibiotics in order to prevent and control overall antibiotic resistance, according to Dr Miller. Most hospitals do not currently have a fully functional antibiotic stewardship program, either through lack of understanding, competing resources, inadequate tools or personnel, or lack of administrative support.
“More and more, healthcare facilities see the advantages of an antibiotic stewardship program and its beneficial effects on patient outcomes as well as on antibiotic resistance in general, with increasing adoption of such efforts,” said Dr Miller. “The ‘cost’ of not having an antibiotic stewardship program is the resultant inappropriate use of antibiotics which will increase overall antibiotic resistance.”
Management of antibiotic formularies in all healthcare facilities (acute, long-term, rehabilitation) is a major component of any antibiotic stewardship program, according to Dr Miller.
“The tools and personnel required are well-known but the operationalization of such a program requires an individualized tailored approach to the particularities of each healthcare setting. Like managers of other quality programs, antibiotic stewardship principles are well-known but the obstacles to its adoption are institution-specific,” he said.
Formulary managers can prepare by learning how to best implement and support an effective antibiotic stewardship program and how to adapt it to their healthcare facility.
Here, Dr Miller helps identify the 7 core components of a successful antimicrobial stewardship program.
#1. Leadership commitment
Dedicate necessary administrative support-CEO, CFO, directors, managers-to dedicate the human, financial and information technology resources necessary to perform the program.
Involve highly-placed administrators (ie, CEO) to take direct responsibility for the outcome of the program. The appointment of a single leader, widely respected and supported by personnel and administration, who is responsible for program and its outcomes.
#3. Drug expertise
“Appoint a chief pharmacist to take direct responsibility for the outcome of the program,” Dr Miller said.
Start progressive implementation of actions, from “simple” to “complex” in a methodical and planned manner.
Dr Miller advises starting with a high-impact and low-resource-requiring project to show rapid and impactful success, in order to achieve ‘buy in’ from the facility and stakeholders..
Monitor all of the necessary objectives which relate to appropriate antibiotic use: Overall antibiotic prescribing, appropriate antibiotic use, resistance patterns, etc.
This should include regular reporting of information related to the stewardship program, its impact on the chosen objectives being tracked, and the impact on personnel, the facility, patients and the community.
Educate clinicians, other healthcare personnel, patients and the community about resistance and appropriate antibiotic use.
Dr Miller explained 2 significant keys to a successful program. An effective Antimicrobial Stewardship Program Team should include at least 1 infectious diseases physician and at least 1 clinical pharmacist. Additionally, having multiple operational strategies but with an emphasis on “prospective audit and feedback” as the key strategy-the most validated intervention for achieving stewardship goals. Other strategies might include: “antibiotic time-outs,” “antibiotic restriction/prior authorization” and disease-specific focused interventions, he said.
In terms of cost to an institution to create and support an antibiotic stewardship program, this varies tremendously on many variables, according to Dr Miller: The size of the institution, the complexity of the patient population, the informatics available to connect important information (microbiology results, other lab results, pharmacy information, etc.), the hours of “coverage” (eg, daytime or 24-hour stewardship) and the number/type of people needed to implement the program.