Antimicrobial Stewardship in Australia

Background: Data collected through the Australian Antimicrobial Usage Surveillance Program demonstrates a higher rate of antimicrobials in Australian hospitals compared to Europe with the use of cephalosporins and macrolides higher than in other countries. Along with infection control, hand hygiene and surveillance, antimicrobial stewardship is considered a key strategy in a national program to decrease preventable infections
Objective: The objective of the Australian Antimicrobial Program is the development of antimicrobial stewardship programs to optimise the use of antimicrobials to prevent and contain antimicrobial resistance
Methods: The publication of Reducing harm to patients: Antimicrobial stewardship programs in Australian hospitals was designed for clinicians and health administrators. It describes the elements of an antimicrobial stewardship program and the evidence to support inclusion in hospital quality and safety programs to improve the selection and use of antimicrobial therapy to reduce adverse outcomes from inappropriate use. Restrictive and educational strategies are described with guidance on developing and introducing a stewardship program, the cultural changes required and the resources needed for an effective program
Results:

Evidence-based recommendations were developed to include the following strategies:

„      Clinical guidelines incorporating local microbiology and antimicrobial susceptibility „       Formulary restriction and approval systems which restrict broad spectrum and later generation antimicrobials
„       Clinical microbiology laboratory reporting of restricted susceptibility testing results consistent with institutional antimicrobial guidelines
„       Review and audit of antimicrobial prescribing with intervention and direct feedback to the prescriber
„       Effective education of prescribers and pharmacists about antimicrobial usage, resistance and judicious prescribing
„       Clinical decision support and on-line approval systems
„       Monitoring performance of antimicrobial prescribing by collection and reporting of ward-specific antimicrobial dispensing data, antimicrobial use and application of quality use of medicines
„       Annual publication of facility-specific antimicrobial susceptibility data
„       Support of hospital administration to measure and monitor antimicrobial usage
„       A multidisciplinary antimicrobial stewardship team with core membership of an infectious diseases physician or clinical microbiologist and a clinical pharmacist
„       Residence within the hospital’s quality improvement and patient safety governance structure with strong links between stewardship, drug and therapeutics and infection control

Conclusions: Effective hospital antimicrobial stewardship programs have been shown to decrease antimicrobial use and improve patient care, optimise use among hospital patients, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use and resistance