Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program

Abstract

Regardless of one’s opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

“…ASPs may vary by healthcare institutions; therefore, flexible and tailored approaches to local needs are essential. 252 , 253 …”

Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

“…To combat rising antimicrobial resistance, several antimicrobial stewardship strategies have been proposed and implemented at the hospital and community level [ 3 ]. These include, but are not limited to, developing local treatment guidelines according to local pathogen-susceptibility data, establishing antimicrobial stewardship teams in tertiary care centers, preauthorization of prescriptions and post prescription audit and review, education and practical training, monitoring antimicrobial use and disease epidemiology [ 5 , 6 ].…”

Assessing feasibility of establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study

“…As recommended in a recent review of AMS programme designs, practically integrating the planned changes into the normal routine clinical practices is the best way to achieve sustainability apart from securing long-term resources. 34 Making PAF activities routine can contribute to the sustainability of the AMS programme. In addition, developing methods and staff capacity to utilise the existing routinely collected data (clinical, pharmacy and microbiology) was also a priority in our programme.…”

“…Among these considerations, capacity building and training for the AMS team in programme planning and evaluation and hospital pharmacists to conduct PAF activities were identified as the key components. As recommended in a recent review of AMS programme designs, practically integrating the planned changes into the normal routine clinical practices is the best way to achieve sustainability apart from securing long-term resources 34. Making PAF activities routine can contribute to the sustainability of the AMS programme.…”