New position paper outlines national approach to antimicrobial stewardship

As the supply of life-saving antibiotics becomes increasingly threatened, infectious diseases experts urge healthcare systems and policymakers to step up efforts to protect patients by preserving the effectiveness of available antibiotics through antimicrobial stewardship initiatives.

A new position paper from the Society for Healthcare Epidemiology of America (SHEA), Infectious Diseases Society of America (IDSA) and Pediatric Infectious Diseases Society (PIDS) outlines measures necessary to improve the use and ensure the impact of antibiotics on emerging healthcare associated infections. The paper is being published in the April issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, in a special topic issue focused on antimicrobial stewardship.

Antimicrobial stewardship (AS) programs and interventions help prescribers know when antibiotics are needed and what the best treatment choices are for a particular patient to help improve the use of these drugs.

"Antibiotic stewardship is a critical component of providing quality care in any health setting," said Neil Fishman, MD, SHEA past president and position paper author. "Effective stewardship will improve outcomes, conserve limited resources and limit emergence of resistance."

Antimicrobial stewardship interventions have the potential to improve the quality of patient care throughout the United States, reduce healthcare costs associated with unnecessary treatments and help preserve the use of antibiotics for generations to come.

"With few antibiotics in the pharmaceutical pipeline, we must take the necessary measures to preserve our current supply of antibiotics, and ensure that our children have access to these lifesaving medications." said Christopher J. Harrison, MD, chair of the Pediatric Infectious Diseases Society's Clinical Affairs Committee.

National antimicrobial stewardship initiatives recommended in the paper include:

• Incorporate antimicrobial resistance and AS into the curriculum for healthcare professionals to ensure that practicing providers are knowledgeable in these areas.
• Collect data on antimicrobial use in both inpatient and outpatient settings. These data are critical to monitor antibiotic use and its relationship to antibiotic resistance.
• Monitor AS initiatives in ambulatory and outpatient healthcare settings. SHEA, IDSA and PIDS encourage federal agencies to fund pilot projects designed to develop and implement AS programs in these settings, including expanded use of electronic health records.
• Require health settings to implement AS programs through regulatory mechanisms. The authors recommend that the Centers for Medicare and Medicaid (CMS) require participating healthcare institutions to develop and implement AS programs to help optimize the use of antibiotics.
• Fill the knowledge gaps in our understanding of antibiotics resistance to increase our understanding of the transmission of resistance and assessing the impacting of clinical interventions.

Antimicrobial stewardship should be considered part of a multifaceted approach necessary to prevent, detect and control the emergence of antimicrobial resistant organisms. Other necessary components include developing new diagnostic tools and antibiotics to help health care providers rapidly and reliably detect and treat specific bacteria and resistant strains.

"We're not developing new drugs fast enough to keep up with the rise in drug-resistant infections," said Ruth Lynfield, MD, chair of Infectious Diseases Society of America's National and Global Public Health Committee. "Antimicrobial stewardship strategies are the best way to immediately address this issue, and protect the effectiveness of the next generation of antibiotics."