Limits...
Antimicrobial stewardship: attempting to preserve a strategic resource.

Van Schooneveld T - J Community Hosp Intern Med Perspect (2011)

Bottom Line: Both strategies have some limitations, but have been effective at achieving stewardship goals.Other supplemental strategies such as education, clinical prediction rules, biomarkers, clinical decision support software, and institutional guidelines have been effective at improving antimicrobial use.The most effective antimicrobial stewardship programs have employed multiple strategies to impact antimicrobial use.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA.

ABSTRACT
Antimicrobials hold a unique place in our drug armamentarium. Unfortunately the increase in resistance among both gram-positive and gram-negative pathogens coupled with a lack of new antimicrobial agents is threatening our ability to treat infections. Antimicrobial use is the driving force behind this rise in resistance and much of this use is suboptimal. Antimicrobial stewardship programs (ASP) have been advocated as a strategy to improve antimicrobial use. The goals of ASP are to improve patient outcomes while minimizing toxicity and selection for resistant strains by assisting in the selection of the correct agent, right dose, and best duration. Two major strategies for ASP exist: restriction/pre-authorization that controls use at the time of ordering and audit and feedback that reviews ordered antimicrobials and makes suggestions for improvement. Both strategies have some limitations, but have been effective at achieving stewardship goals. Other supplemental strategies such as education, clinical prediction rules, biomarkers, clinical decision support software, and institutional guidelines have been effective at improving antimicrobial use. The most effective antimicrobial stewardship programs have employed multiple strategies to impact antimicrobial use. Using these strategies stewardship programs have been able to decrease antimicrobial use, the spread of resistant pathogens, the incidence of C. difficile infection, pharmacy costs, and improved patient outcomes.

No MeSH data available.


Related in: MedlinePlus

Antimicrobial stewardship targets and objectives.
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Figure 0001: Antimicrobial stewardship targets and objectives.

Mentions: A proposed solution to the combined problems of increasing antibiotic resistance, the dwindling number of antimicrobial agents, and the suboptimal use of antibiotics in clinical practice is the strategy of antimicrobial stewardship. The term ‘stewardship’ describes the careful or responsible management of a valued entity entrusted to one's care. Antimicrobial agents should be viewed as a shared resource that must be managed with an eye to preservation of their use for future generations (32). Antimicrobial stewardship is defined as interventions to improve the appropriate use of antimicrobials through promotion of optimal agent selection, dosing, duration, and route of administration. The objectives of antimicrobial stewardship are focused on achieving optimal clinical outcomes while minimizing toxicity, adverse events, and selection for antimicrobial resistant strains. Cost reduction may be a result of stewardship programs but should not be an overarching goal (Fig. 1).


Antimicrobial stewardship: attempting to preserve a strategic resource.

Van Schooneveld T - J Community Hosp Intern Med Perspect (2011)

Antimicrobial stewardship targets and objectives.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3714030&req=5

Figure 0001: Antimicrobial stewardship targets and objectives.
Mentions: A proposed solution to the combined problems of increasing antibiotic resistance, the dwindling number of antimicrobial agents, and the suboptimal use of antibiotics in clinical practice is the strategy of antimicrobial stewardship. The term ‘stewardship’ describes the careful or responsible management of a valued entity entrusted to one's care. Antimicrobial agents should be viewed as a shared resource that must be managed with an eye to preservation of their use for future generations (32). Antimicrobial stewardship is defined as interventions to improve the appropriate use of antimicrobials through promotion of optimal agent selection, dosing, duration, and route of administration. The objectives of antimicrobial stewardship are focused on achieving optimal clinical outcomes while minimizing toxicity, adverse events, and selection for antimicrobial resistant strains. Cost reduction may be a result of stewardship programs but should not be an overarching goal (Fig. 1).

Bottom Line: Both strategies have some limitations, but have been effective at achieving stewardship goals.Other supplemental strategies such as education, clinical prediction rules, biomarkers, clinical decision support software, and institutional guidelines have been effective at improving antimicrobial use.The most effective antimicrobial stewardship programs have employed multiple strategies to impact antimicrobial use.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA.

ABSTRACT
Antimicrobials hold a unique place in our drug armamentarium. Unfortunately the increase in resistance among both gram-positive and gram-negative pathogens coupled with a lack of new antimicrobial agents is threatening our ability to treat infections. Antimicrobial use is the driving force behind this rise in resistance and much of this use is suboptimal. Antimicrobial stewardship programs (ASP) have been advocated as a strategy to improve antimicrobial use. The goals of ASP are to improve patient outcomes while minimizing toxicity and selection for resistant strains by assisting in the selection of the correct agent, right dose, and best duration. Two major strategies for ASP exist: restriction/pre-authorization that controls use at the time of ordering and audit and feedback that reviews ordered antimicrobials and makes suggestions for improvement. Both strategies have some limitations, but have been effective at achieving stewardship goals. Other supplemental strategies such as education, clinical prediction rules, biomarkers, clinical decision support software, and institutional guidelines have been effective at improving antimicrobial use. The most effective antimicrobial stewardship programs have employed multiple strategies to impact antimicrobial use. Using these strategies stewardship programs have been able to decrease antimicrobial use, the spread of resistant pathogens, the incidence of C. difficile infection, pharmacy costs, and improved patient outcomes.

No MeSH data available.


Related in: MedlinePlus