Antimicrobial Stewardship Program

"Antibiotics are a shared community property or trust, and clinicians, health care organizations, patients, and the public are bound together in the need to protect these drugs from misuse."

JAMA, March 2016

Why are antibiotics a "shared community property"?

• They are the only drugs that have transmissible loss of efficacy over time
• There are very few new antibiotics in development

How are antibiotics being misused?

• They are prescribed when they are not needed (antibiotics for viral infections)
• They are prescribed longer than they should be
• They are prescribed at inappropriate doses
• Broad antibiotics are given when a narrow spectrum antibiotic can be used
• The wrong antibiotic is prescribed for certain infections

How misusing antibiotics is a problem

• Increases the rate of multidrug resistant bacteria
• The Center for Disease Control and Prevention (CDC) estimates that more than two million people are infected with antibiotics resistant organisms resulting in approximately 23,000 deaths
• Increases the rate of Clostridium difficile infection (CDI)
• The CDC estimates around 25,000 CDIs per year resulting in approximately 14,000 deaths with close to one billion dollars in excess medical costs per year
• Increases side effects of antibiotics
• Increases patient morbidity and mortality
• Increases hospital length of stay
• Increases re-admission rates

 

In recognition of the urgent need to use antibiotics appropriately, the CDC, Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), and The Joint Commission recommended that all hospitals implement an Antimicrobial Stewardship Program (ASP)

ASP is a program that consists of a multidisciplinary team including Infectious Diseases physician and Infectious Diseases pharmacist working closely with hospital administration, microbiology, infection control, information technology, and nursing to improve antibiotic use by ensuring that patients receive

• the right antibiotic
• at the right dose
• at the right time
• for the right duration