Antimicrobial Stewardship: A Primer for Hospital Pharmacists

MARCH 24, 2016
Kathy Tang, PharmD, and Emily L. Heil, PharmD, BCPS-AQ ID, AAHIVP
The Centers for Disease Control and Prevention (CDC) has reported that 20% to 50% of all antibiotics prescribed in US acute care hospitals are either unnecessary or inappropriate, resulting in avoidable adverse effects, bacterial resistance, and an increased incidence of Clostridium difficile infection.1 The evolution of multidrug resistant organisms has limited the available antimicrobial treatment choices, making the improvement of antibiotic use a public health priority.1 As a result, there has been increased interest in establishing antimicrobial stewardship programs, nationwide.

Antimicrobial stewardship is a coordinated approach that aims to improve the appropriate use of antimicrobials, thereby reducing antimicrobial resistance and improving patient outcomes through targeted interventions. Effective antimicrobial stewardship programs have substantially improved clinical outcomes, decreased use of unnecessary antimicrobials, reduced C difficile infections, and reduced drug resistance.1 Although these programs are also associated with potential annual savings in antimicrobial expenditures, such financial gains are often seen early in program development and may plateau over time.2 Comparatively, the clinical effects of these programs have lasting benefits for institutions.

In response to the antibiotic resistance crisis, the White House has published the National Action Plan for Combating Antibiotic-Resistant Bacteria.1,3

President Barak Obama issued an Executive Order on Combating Antibiotic-Resistant Bacteria in September 2014. The National Action Plan was developed as guidance for implementing the Executive Order, with goals to slow the emergence of ment of diagnostic tools to identify resistant bacteria, promote and accelerate research for new antibiotics and vaccines, and strengthen surveillance efforts.3 Importantly, the plan establishes that, by 2020, antimicrobial stewardship programs should be active in all acute care hospitals, and inappropriate antibiotic use should be reduced by 50% in outpatient settings and 20% in inpatient settings.3 To do this, the plan recommends a regulatory requirement for antimicrobial stewardship be in place by 2017.