A narrative review of antimicrobial stewardship interventions within in-patient settings and resultant patient outcomes

Abstract

A BSTRACT The overuse of antibiotics has led to various healthcare problems such as the emergence of resistance in infectious microbes and mortality due to antibiotic resistant healthcare associated infections (HAIs). An antimicrobial stewardship (AMS) program is the set of interventions used worldwide to enhance the rational use of antibiotics especially for the hospitalized patients. This review aimed to describe the characteristics of the implemented AMS programs in various hospitals of the world mainly focusing on the interventions and patients outcomes. The literature about AMS program was searched through various databases such as PubMed, Google Scholar, Science Direct, Cochran Library, Ovid (Medline), Web of Science and Scopus. In this review the literature pertaining to the AMS programs for hospitalized patients is sorted on the basis of various interventions that are categorized as formulary restriction (pre-authorization), guideline development, clinical pathway development, educative interventions and prospective audit. Moreover a clear emphasis is laid on the patient outcomes obtained as a result of these interventions namely the infection control, drop in readmission rate, mortality control, resistance control and the control of an overall cost of antibiotic treatment obtained mainly by curbing the overuse of antibiotics within the hospital wards. AMS program is an efficient strategy of pharmacovigilance to rationalize the antimicrobial practice for hospitalized patients as it prevents the misuse of antibiotics, which ultimately retards the health threatening effects of various antibiotics.

Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy

“…Publication of institutional guidelines and education are key steps in developing an AMS program. Various studies highlight that the dissemination and implementation of guidelines, together with the educational processes, increase the effectiveness of AMS programs with favorable effects on antibiotic use, costs, and mortality from multidrug-resistant infections [39].…”

Where to start? The Irish Emergency Department Antimicrobial Discharge (EDAD) study: a multicentre, prospective cohort analysis

“… 9 Stewardship programmes rarely target this interface for their initiatives, 7 instead tailoring interventions towards doctors in training and in-patient prescribing practices. 10 The ED presents challenges to effective AMS interventions, compared with inpatient settings. For example, there are more time constraints with higher patient turnover that may influence prescribing decisions.…”

Pharmacovigilance Data as a Trigger to Identify Antimicrobial Resistance and Inappropriate Use of Antibiotics: A Study Using Reports from The Netherlands Pharmacovigilance Centre

“…A global coordination is challenged by limited antimicrobial stewardship interventions at the level of primary health care, the dispensing of antimicrobials without prescription in pharmacies, and the extended use of antimicrobials in non-human sectors [ 6 ]. As a program, antimicrobial stewardship is a set of all interventions used to enhance the rational use of antibiotics [ 7 ]. Various forms of antimicrobial stewardship programs have been established in different countries [ 8 ] at different levels of care delivery with involvement of a wide range of stakeholders including clinicians, pharmacists, nurses, and administrators and healthcare facilities [ 9 , 10 , 11 ].…”