What is antimicrobial stewardship?

2017年CMIから報告された、"What is antimicrobial stewardship?"

www.ncbi.nlm.nih.gov

下のASP関係図いいですね。

関係図は、複雑であり、コミュニケーション向上がkey。

いかに、患者を巻き込み、環境を作るのかが重要ですな。

Abstract

BACKGROUND:

The use of the term 'antimicrobial stewardship' has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and One Health. As the use of the term 'antimicrobial stewardship' becomes more common, it is important to consider what antimicrobial stewardship is, as well as what it is not.

AIMS:

To review the emergence and evolution of the term 'antimicrobial stewardship'.

SOURCES:

We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We contacted the authors of the first publications that mentioned antimicrobial stewardship.

CONTENT:

We describe the historical background behind how antimicrobial stewardship came into use in clinical settings. We discuss challenges emerging from the varied descriptions of antimicrobial stewardship in the literature, including an over-emphasis on individual prescriptions, an under-emphasis on the societal implications of antimicrobial use, and language translation problems.

IMPLICATIONS:

To help address these challenges, we suggest viewing antimicrobial stewardship as a strategy, a coherent set of actions which promote using antimicrobials responsibly. We stress the continuous need for 'responsible use' to be defined and translated into context-specific and time-specific actions. Furthermore, we present examples of actions that can be undertaken within antimicrobial stewardship across human and animal health.

Descriptions of activitie

Antimicrobial stewardship includes optimal selection, dose and duration of treatment, as well as control of antibiotic use 
Antimicrobial stewardship refers to the responsible use of antimicrobials by healthcare professionals, and more specifically, to selection of the most appropriate antibiotic, duration, dose, and route of administration for a given patient with a demonstrated or suspected infection 

Descriptions of goals

The primary goal of antimicrobial stewardship is to optimize clinical outcomes whilst minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms, and the emergence of resistance

As a program or set of interventions

AMS refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug regimen including dosing, duration of therapy and route of administration.

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.
Antimicrobial stewardship refers to a program or series of interventions to monitor and direct antimicrobial use at a healthcare institution, thus providing a standard, evidence-based approach to judicious antimicrobial use.

A program that supports selection, dosing, routes of administration and duration of antimicrobial therapy

As an approach or method

Antimicrobial stewardship refers to the multifaceted approach (including policies, guidelines, surveillance, prevalence reports, education and audit of practice) that healthcare organizations have adopted to optimize prescribing

Antimicrobial stewardship is a method of overseeing antimicrobial use in healthcare facilities to ensure that every patient requiring antimicrobial therapy receives optimal therapy

As a means to tackle resistance

Antimicrobial stewardship is a key component of a multifaceted approach to preventing emergence of antimicrobial resistance
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

A critical mission of preservation of antimicrobial utility

As responsible use

Antimicrobial stewardship programs are a set of interventions that aim to ensure the judicious use of antimicrobials by preventing their unnecessary use, and by providing targeted and limited therapy in situations where they are wanted

[Stewardship] refers to how the judicious use of antibiotics can maximize both their current effects and the chances of their being available for future generations

Descriptions of good stewardship

Good antimicrobial stewardship is the optimal selection, dose, and duration of an antimicrobial that results in the best clinical outcome for the treatment or prevention of infection, with minimal toxicity to the patient and minimal impact on subsequent resistance. Good antimicrobial stewardship is akin to motherhood and apple pie

Good antimicrobial stewardship involves selecting an appropriate drug and optimizing its dose and duration to cure an infection while minimizing toxicity and conditions for selection of resistant bacterial strains

Descriptions of antimicrobial stewardship from the literature

Prescriber

I use antimicrobials responsibly by

• Making accurate diagnoses

• Following local antimicrobial

  guidelines

• Regularly reviewing

  the need for therapy

Nurse

I help ensure antimicrobials are used responsibly by

• Taking cultures at appropriate times

• Ensuring patients

  understand how to take antimicrobials on discharge

Patient

I use antimicrobials responsibly by

• Taking antimicrobial courses as

  recommended by the

  prescriber

• Not storing or using

  leftover antimicrobials

AMS team

We help others in our institution use antimicrobials responsibly by

• Developing guidelines for antimicrobial use

• Supporting audit and

  feedback for

  prescribers

• Educating prescribers

Hospital governance

Our institution uses antimicrobials responsibly by

• Ensuring sufficient sustainable and dedicated funding for AMS teams

• Monitoring antimicrobial use and resistance

• Investing in CDSS

• Enabling formulary

  restrictions

Producer/farmer

I use antimicrobials responsibly by

• Diagnosing selectivity

• Not using antimicrobials as growth promoters

Pharmaceutical company

Our company ensures antimicrobials are used responsibly by

• Limiting advertising of antimicrobials,

  especially broad

  spectrum

• Helping ensure there is

  a continuous supply of antimicrobials

National policy maker

Our country uses antimicrobials by

• Prioritising and funding AMS activities

• Supporting the use of quality metrics and pay for performance