Advertisement

Antimicrobial stewardship: A collaborative partnership between infection preventionists and health care epidemiologists

      Misuse and overuse of antimicrobials, primarily involving therapeutic agents used to treat infection in humans, is considered one of the world’s most pressing public health problems.
      • Bartlett J.G.
      A call to arms: the imperative for antimicrobial stewardship.
      Not only does such inappropriate use diminish the therapeutic benefit of essential medications, it also facilitates the development and spread of multidrug resistant organisms (MDROs).
      • Cuzon G.
      • Naas T.
      • Truong H.V.
      • Villegas M.-V.
      • Wisell K.T.
      • Carmeli Y.
      • et al.
      Worldwide diversity of Klebsiellapneumoniae that produce β-lactamase blaKPC-2 gene.
      Antimicrobial resistance and the rise in MDROs globally are associated with increased morbidity and mortality, cross-transmission within and between health care settings, and increased consumption of limited patient care resources. Despite elevated awareness, publication of guidelines on antimicrobial stewardship,
      • Dellit T.H.
      • Owens R.C.
      • McGowan Jr., J.E.
      • Gerding D.N.
      • Weinstein R.A.
      • Burke J.P.
      • et al.
      Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.
      and several initiatives, the proportion of resistant strains causing both health care and community-associated infections continues to increase and the number of new antimicrobials continues to decline.
      • Hidron A.I.
      • Edwards J.R.
      • Patel J.
      • Horan T.C.
      • Sievert D.M.
      • Pollock D.A.
      • et al.
      National Healthcare Safety Network Team. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007.
      • Kumarasamy K.K.
      • Toleman M.A.
      • Walsh T.R.
      • Bagaria J.
      • Butt F.
      • Balakrishnan R.
      • Chaudhary U.
      • et al.
      Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bartlett J.G.
        A call to arms: the imperative for antimicrobial stewardship.
        Clin Infect Dis. 2011 Aug; 53: S4-S7
        • Cuzon G.
        • Naas T.
        • Truong H.V.
        • Villegas M.-V.
        • Wisell K.T.
        • Carmeli Y.
        • et al.
        Worldwide diversity of Klebsiellapneumoniae that produce β-lactamase blaKPC-2 gene.
        Emerg Infect Dis [serial on the Internet]. 2010 Sep; 16 (Available at) (Accessed July 25, 2011): 9
        • Dellit T.H.
        • Owens R.C.
        • McGowan Jr., J.E.
        • Gerding D.N.
        • Weinstein R.A.
        • Burke J.P.
        • et al.
        Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.
        Clin Infect Dis. 2007; 44: 159-177
        • Hidron A.I.
        • Edwards J.R.
        • Patel J.
        • Horan T.C.
        • Sievert D.M.
        • Pollock D.A.
        • et al.
        National Healthcare Safety Network Team. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007.
        Infect Control Hosp Epidemiol. 2008 Nov; 29: 996-1011
        • Kumarasamy K.K.
        • Toleman M.A.
        • Walsh T.R.
        • Bagaria J.
        • Butt F.
        • Balakrishnan R.
        • Chaudhary U.
        • et al.
        Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.
        Lancet Infect Dis. 2010 Sep; 10 (Epub 2010 Aug 10): 597-602
      1. Centers for Disease Control & Prevention (CDC). Get smart: Know when antibiotics work. Available at: http://www.cdc.gov/getsmart/. Accessed November 23, 2011 (landing page – main).

      2. CDC. Get smart for healthcare. Available at: http://www.cdc.gov/getsmart/healthcare/?s_cid=dhqp_002. Accessed November 23, 2011.

      3. World Health Organization (WHO). World Health Day – 7 April 2011. Antimicrobial resistance: no action today, no cure tomorrow. Available at: http://www.who.int/world-health-day/2011/en/index.html. Accessed November 23, 2011.

        • Fishman N.
        Antimicrobial stewardship.
        Am J Infect Control. 2006; 34: S55-S63
      4. The Joint Commission (TJC). Assets for Acute Care Hospital Accreditation 2011. From Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace [IL]: TJC, 2011. Available at: http://www.jointcommission.org/assets/1/6/2011_NPSGs_HAP.pdf. Accessed May 7, 2011.

      5. California State Senate Bill 739. Available at: http://www.dhcs.ca.gov/provgovpart/initiatives/nqi/Documents/SB739.pdf. Accessed January 19, 2012.

        • Hayashi Y.
        • Paterson D.L.
        Strategies for reduction in duration of antibiotic use in hospitalized patients.
        Clin Infect Dis. 2011 May; 52: 1232-1240
        • Ohl C.A.
        • Dodds Ashley E.S.
        Antimicrobial stewardship programs in community hospitals: the evidence base and case studies.
        Clin Infect Dis. 2011; 53: S23-S28
        • Septimus E.J.
        • Owens Jr., R.J.
        Need and Potential of Antimicrobial Stewardship in Community Hospitals.
        Clin Infect Dis. 2011; 53: S8-S14

      Additional resources

        • Carrico R.
        • Archibald L.K.
        • Bryant K.
        • Dubberke E.
        • Fauerbach L.L.
        • Garcia J.G.
        • et al.
        Guide to the Elimination of Clostridium difficile in Healthcare Settings.
        APIC, Washington DC2008
      1. Dubberke ER, Gerding DN, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals. In: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. Available at: http://www.jstor.org/stable/10.1086/591065; 2008.

        • Siegel J.D.
        • Rhinehart E.
        • Jackson M.
        • Chiarello L.
        The Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms.
        In: Healthcare Settings. 2006; (Available at)
      2. WHO Strategy for Containment of Antimicrobial Resistance.
        World Health Organization Press, Geneva, Switzerland2001 (Available at)
      3. NQF SCIP. Available at: http://www.qualityforum.org/Projects/s-z/Surgery/Surgery_Related_and_Competing_Measures.aspx.