1 The concept of AMS
Activity 2: Initial reflections
Think about your healthcare facility and your role in it.
- Is there a general awareness of the need for stewardship of antimicrobials?
- Is there a structure in your facility such as a stewardship committee? Or is stewardship part of the role of other committees, such as the drugs and therapeutics committee?
- If you have a stewardship committee, do you feel that it communicates effectively? Does it educate individuals to make appropriate decisions on AMU?
- Are you aware of audits or surveys such as point prevalence surveys (PPSs) to monitor antimicrobial prescribing practice?
Note down your thoughts in the space below.
Discussion
You might have thought that there is some awareness of AMS in your facility but that clinicians are still making individual prescribing decisions without enough guidance, or that you are not receiving updated guidance based on monitoring of AMU.
AMU in human and veterinary medicine is one of the main drivers of
AMS may not be prioritised in resource-poor settings, but it is estimated that in selected low- and middle-income countries (LMICs), the proportion of resistant infections ranges from 40 to 60% compared to an average of 17% for high-income countries belonging to the Organisation for Economic Co-operation and Development (OECD; WHO, 2019b). This demonstrates the need for introducing or improving stewardship in all healthcare settings, and this course will address some key components in the process.
Stewardship measures aimed at optimising AMU decrease the development of AMR while reducing associated costs: this has been shown in African countries and provides encouragement for LMICs to develop AMS (Akpan, 2020). Healthcare facilities are at major risk of developing problems with AMR because they are major consumers of antimicrobial agents, and so they benefit enormously from AMS.
However, it is important to understand that AMS programmes are not unique to healthcare facilities and community practice, although this will be the focus of this course. AMS is also relevant to AMU in domestic, wild and food animals, as well as agricultural AMU on crop plants.
Stewardship in this wider context will benefit individuals being treated for infection, and reduce potential AMR in pathogens that cause animal and plant diseases. It will also reduce the potential spread of AMR in the environment through transmission of resistant microbes and antimicrobial genes, as well as antimicrobials and their metabolites excreted into soil or entering via wastewater (see the Introducing a One Health approach to AMR course).
If your country has a National Action Plan (NAP), it is likely to include recommendations for antimicrobial stewardship and optimising the use of antimicrobials. This is covered extensively in the UK’s most recent NAP [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , covering the period 2024–29 (UK Government, 2024); see particularly ‘Theme 2: Optimising the use of antimicrobials’. How does this compare with your own country’s provisions?
Introduction
