Antimicrobial stewardship: what is it, and how does it work?
J. TurnidgeAustralian Commission on Safety and Quality in Health Care, Sydney, NSW 2000, Australia, and Departments of Pathology, Paediatrics and Molecular and Biomedical Science, University of Adelaide, Adelaide, SA 5005, Australia. Email: jturnidge@gmail.com; john.turnidge@safetyandquality.gov.au
Animal Production Science 55(12) 1432-1436 https://doi.org/10.1071/AN15272
Submitted: 1 June 2015 Accepted: 22 August 2015 Published: 12 October 2015
Abstract
Antimicrobial stewardship is emerging as a vital management tool in the efforts to contain antimicrobial resistance and retain the efficacy of available agents. It is based on a set of concepts about antimicrobial use and resistance that have been developed over the past 70 years. There are seven basic requirements for a stewardship program to function at a local level, including (1) ‘executive’ ownership of the issue, (2) consensus prescribing guidelines, (3) a local formulary with various levels of restricted access, (4) a local champion (or champions) who is a trusted peer, (5) authority to intervene in prescribing and/or dispensing, (6) authority for measurement of use, audit and feedback, and (7) access to reliable laboratory services and their cumulative resistance data. Stewardship programs are most advanced in larger public hospitals, but there is considerable interest and need for developing programs tailored to a wide range of settings in human and animal health, each with their own particular characteristics of access to antimicrobials and potential controls. The potential value of stewardship in food animal production is now recognised globally, and Australia has taken the first steps towards surveillance and stewardship in this sector, supported by a recently released national One Health strategy on the containment of antimicrobial resistance.
Additional keywords: antimicrobial resistance, authority for measurement, authority to intervene, prescribing guidelines.
References
Antibiotic Expert Groups (2014) ‘Therapeutic guidelines: Antibiotic. Version 15.’ (Therapeutic Guidelines Limited, Melbourne)Antimicrobial Resistance Standing Committee (2014) ‘Importance ratings and Summary of Antibacterial Uses in Humans in Australia.’ (Australian Commission on Safety and Quality in Health Care: Sydney)
Australian Commission on Safety and Quality in Health Care (2013) A specification for hospital cumulative antibiograms. (Australian Commission on Safety and Quality in Health Care: Sydney)
Australian Commission on Safety and Quality in Health Care (2014) Antimicrobial stewardship clinical care standard. (Australian Commission on Safety and Quality in Health Care: Sydney)
Australian Commission on Safety and Quality in Health Care (2015) Antimicrobial prescribing practice in Australian hospitals. Results of the 2014 National Antimicrobial Prescribing Survey. (Australian Commission on Safety and Quality in Health Care: Sydney)
Cooper BS (1994) ‘Anti-infective agents in veterinary medicine.’ (Post Graduate Foundation in Veterinary Science in association with National Health & Medical Research Council, University of Sydney: Sydney)
Cooper BS (2000) ‘Anti-infective agents in veterinary medicine.’ 2nd edn. (Post Graduate Foundation in Veterinary Science in association with National Health & Medical Research Council, University of Sydney: Sydney)
Department of Health (2015) ‘Antimicrobial resistance (AMR): the national AMR strategy.’ Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-amr.htm [Verified May 2015]
Duguid M, Cruickshank M (Eds) (2010) ‘Antimicrobial stewardship in Australian hospitals.’ (Australian Commission on Safety and Quality in Health Care: Sydney)
Guardabassi L, Prescott JF (2015) Antimicrobial stewardship in small animal veterinary practice: from theory to practice. The Veterinary Clinics of North America. Small Animal Practice 45, 361–376.
| Antimicrobial stewardship in small animal veterinary practice: from theory to practice.Crossref | GoogleScholarGoogle Scholar | 25721619PubMed |
Guidance MS (2015) ‘iApprove module.’ Available at http://www.guidancems.org.au/pages.php?id=5 [Verified August 2015)
Harvey K, Dartnell J, Hemming M (2003) Improving antibiotic use: 25 years of antibiotic guidelines and related initiatives. Communicable Diseases Intelligence Quarterly Report 27, S9–S12.
Hillier A, Lloyd DH, Weese JS, Blondeau JM, Boothe D, Breitschwerdt E, Guardabassi L, Papich MG, Rankin S, Turnidge JD, Sykes JE (2014) Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Veterinary Dermatology 25, 163–175.
| Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases).Crossref | GoogleScholarGoogle Scholar | 24720433PubMed |
Joint Expert Technical Advisory Committee on Antibiotic Resistance (JETACAR) (1999) Report of the Joint Expert Technical Advisory Committee on Antibiotic Resistance (JETACAR). Commonwealth of Australia, Canberra.
Marshall BM, Levy SB (2011) Food animals and antimicrobials: impacts on human health. Clinical Microbiology Reviews 24, 718–733.
| Food animals and antimicrobials: impacts on human health.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhs1ejsL7L&md5=cdcd8735197ee41d927a91c4ee2601b3CAS | 21976606PubMed |
Page S (2011) Judicious use of antimicrobial agents. Principles of appropriate use. A report commissioned by the Australian Chicken Meat Federation. Updated September 2011. Available at http://www.chicken.org.au/files/_system/Document/ACMF_Review-Judicious_Use_of_Antimicrobial_ Agents.pdf [Verified August 2015]
Prescott JF, Szkotnicki J, McClure JT, Reid-Smith RJ, Léger DF (2012) Conference report: antimicrobial stewardship in Canadian agriculture and veterinary medicine. How is Canada doing and what still needs to be done? The Canadian Veterinary Journal. La Revue Veterinaire Canadienne 53, 402–407.
Responsible Use of Medicines in Agriculture Alliance (2013) ‘Responsible use of antimicrobials in pig production.’ Second revision. November 2013. Available at http://www.ruma.org.uk/pigs/responsible-use-antimicrobials-pig-production/ [Verified August 2015]
SA Health (2015) ‘Antimicrobial guidelines.’ Available at http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/medicines+and+drugs/antimicrobial+guidelines/antimicrobial+guidelines [Verified May 2015]
Department of Health, Commonwealth of Australia (2015) Schedule of pharmaceutical benefits (effective 1 May 2015 – 31 May 2015) (Department of Health, Commonwealth of Australia: Canberra)
Spinks A, Glasziou PP, Del Mar CB (2013) Antibiotics for sore throat. Cochrane Database of Systematic Reviews 11, CD000023
| Antibiotics for sore throat.Crossref | GoogleScholarGoogle Scholar | 24190439PubMed |
Weese JS, Blondeau JM, Boothe D, Breitschwerdt EB, Guardabassi L, Hillier A, Lloyd DH, Papich M, Rankin SC, Turnidge JD, Sykes JE (2011) Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: antimicrobial guidelines working group of the international society for companion animal infectious diseases. Veterinary Medicine International
| Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: antimicrobial guidelines working group of the international society for companion animal infectious diseases.Crossref | GoogleScholarGoogle Scholar | 21776346PubMed |
Weese JS, Giguère S, Guardabassi L, Morley PS, Papich M, Ricciuto DR, Sykes JE (2015) ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance. Journal of Veterinary Internal Medicine 29, 487–498.
| ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MnltlWlsw%3D%3D&md5=f4feb08b60e1fc5c44403ba3afae2802CAS | 25783842PubMed |
Woolhouse M, Ward M, van Bunnik B, Farrar J (2015) Antimicrobial resistance in humans, livestock and the wider environment. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 370, 20140083
| Antimicrobial resistance in humans, livestock and the wider environment.Crossref | GoogleScholarGoogle Scholar | 25918441PubMed |
