Role of Antimicrobial Stewardship in Infection Prevention
Since the 1980s, there has been a widespread and inappropriate use of antimicrobials in our hospitals. This started in part due to the continual development and marketing of an ever-expanding array of drugs to replace agents that would quickly lose their effectiveness secondary to development of resistance. As antimicrobials began to consume a significant percentage of the hospital pharmacy budget, some hospitals developed antimicrobial management or control programs in an attempt to primarily reduce direct drug costs. These early programs have now evolved into antimicrobial stewardship programs (ASPs) which attempt to also improve the quality and appropriateness of antimicrobial use. The concept of stewardship implies an obligation for responsible management of resources. Today high costs of antimicrobials still persist and are estimated to account for 30 % of a hospital budget . However, costs are now only part of a much larger issue. There has been a dramatic increase in antimicrobial resistance in response to constant antimicrobial exposure in institutions. New drugs effective against resistant strains are in short supply, can have significant toxicity, and can be extremely expensive. Resistance has, in turn, led to increases in length of stay with high indirect healthcare costs. The problem has become so pervasive that the Infectious Disease Society of America (IDSA) has recently recommended that ASPs be required in all acute care hospitals in the United States . ASPs are already obligatory in the United Kingdom and the European Union. As a corollary to minimizing expansion of antimicrobial resistance, ASPs reduce the transmission of resistant bacteria in the hospital setting and the requirement for expensive “isolation measures” and therefore have a significant role in infection prevention.
KeywordsAntimicrobial Resistance Clinical Pharmacist Acute Care Hospital Antimicrobial Stewardship Program Prospective Audit
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