Rational Use of Antimicrobials and Antimicrobial Stewardship Programs
DOI:
https://doi.org/10.5281/zenodo.21613197Keywords:
Antimicrobial resistance, Antimicrobial Stewardship, Rational use of antimicrobials, Infection control, Patient safetyAbstract
Antimicrobial resistance is one of the greatest threats to global public health, primarily driven by the inappropriate use of antibiotics and the spread of multidrug-resistant microorganisms. In this context, Antimicrobial Stewardship Programs have been implemented to promote the rational use of antimicrobials, optimize clinical outcomes, and reduce the emergence of antimicrobial resistance. This study aimed to review the main scientific evidence regarding the effectiveness of these programs in clinical practice. A narrative literature review was conducted using the PubMed/MEDLINE, Scopus, Web of Science, Embase, Virtual Health Library (VHL), and Cochrane Library databases. The analyzed studies demonstrated that stewardship strategies are associated with reduced inappropriate antimicrobial consumption, lower incidence of infections caused by multidrug-resistant microorganisms and Clostridioides difficile, improved appropriateness of antimicrobial therapy, shorter hospital stays, and reduced healthcare costs without compromising patient safety. Furthermore, the integration of multidisciplinary teams, clinical microbiology, institutional protocols, and rapid diagnostic methods enhanced the effectiveness of these interventions. It is concluded that Antimicrobial Stewardship Programs are essential strategies for combating antimicrobial resistance, improving healthcare quality, preserving antimicrobial effectiveness, and achieving better clinical outcomes.
References
1. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Aguilar GR, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. doi:10.1016/S0140-6736(21)02724-0.
2. World Health Organization. GLASS report: Antimicrobial resistance surveillance in the WHO European Region 2024. Geneva: World Health Organization; 2024.
3. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77. doi:10.1093/cid/ciw118.
4. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2(2):CD003543. doi:10.1002/14651858.CD003543.pub4.
5. World Health Organization. WHO policy guidance on integrated antimicrobial stewardship activities. Geneva: World Health Organization; 2021.
6. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-177. doi:10.1086/510393.
7. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2(2):CD003543. doi:10.1002/14651858.CD003543.pub4.
8. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-e77. doi:10.1093/cid/ciw118.
9. Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory infections. Cochrane Database Syst Rev. 2017;10(10):CD007498. doi:10.1002/14651858.CD007498.pub3.
10. Timbrook TT, Morton JB, McConeghy KW, Caffrey AR, Mylonakis E, LaPlante KL. The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review and Meta-analysis. Clin Infect Dis. 2017;64(1):15-23. doi:10.1093/cid/ciw649.
11. Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17(9):990-1001. doi:10.1016/S1473-3099(17)30325-0.
12. Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs. Antimicrob Agents Chemother. 2016;60(8):4840-4852. doi:10.1128/AAC.00825-16.
13. Dik JW, Poelman R, Friedrich AW, Panday PN, Lo-Ten-Foe JR, van Assen S, et al. An integrated stewardship model: antimicrobial, infection prevention and diagnostic stewardship combined. Future Microbiol. 2016;11(1):93-102. doi:10.2217/fmb.15.99.
14. Howard P, Pulcini C, Hara GL, West RM, Gould IM, Harbarth S, et al. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals. J Antimicrob Chemother. 2015;70(4):1245-1255. doi:10.1093/jac/dku497.
15. World Health Organization. WHO policy guidance on integrated antimicrobial stewardship activities. Geneva: World Health Organization; 2021.
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