Antimicrobial stewardship in clinical practice

Introduction

Antimicrobial stewardship (AMS) is a multi-disciplinary, systematic approach that optimises the appropriate use of antimicrobials to improve patient outcomes and limit the emergence of resistant pathogens whilst ensuring patient safety. This definition can be applied from the individual level to global level actions, and across human health, animal health and the environment.

In healthcare, the four components of AMS are:

• structures to oversee stewardship
• facility-level interventions such as local antimicrobial prescribing guidelines
• patient-level interventions based on clinical and laboratory evidence (see the Diagnostic stewardship in clinical practice module)
• monitoring and evaluating antimicrobial use (AMU).

Education and training are also essential for clinicians to understand their role in the appropriate use of antimicrobials.

After completing this module, you will be able to:

• understand the principles of an AMS programme
• understand how to approach setting up an AMS committee
• indicate the place of the laboratory in the AMS process
• develop local prescribing guidelines
• describe AMS strategies such as prospective audit and feedback
• understand quantitative and qualitative ways to assess antimicrobial consumption and use
• appreciate the importance of understanding the pharmacokinetics and pharmacodynamics of antimicrobials in determining the optimum treatment strategy
• appreciate that AMS can be introduced gradually, and that initial emphasis on easier-to-achieve targets can lead to significant improvements
• refer to treatment guidelines and resources (such as WHO modules)
• describe the costs and benefits (cost-effectiveness) of implementing AMS.