The state of antibiotic stewardship programs in 2021: The perspective of an experienced steward

Abstract

Recognition of antibiotic stewardship programs (ASPs) as essential components of quality health care has dramatically increased in the past decade. The value of ASPs has been further reinforced during the coronavirus disease 2019 (COVID-19) pandemic because these programs were instrumental in monitoring antibiotic use, assessing emerging COVID-19 therapies, and coordinating implementation of monoclonal antibody infusions and vaccinations. ASPs are now required across hospital settings as a condition of participation for the Centers for Medicare and Medicaid Services and for accreditation by The Joint Commission. In the 2019 National Healthcare Safety Network annual survey, almost 89% of hospitals met the Seven Core Elements for ASPs defined by the Centers for Disease Control and Prevention. More than 61% of programs were co-led by physicians and pharmacists, evidence of the leadership role of both groups. ASPs employ many strategies to improve prescribing. Core interventions of preauthorization for targeted antibiotics, prospective audit and feedback, and development of local treatment guidelines have been supplemented with numerous emerging strategies. Diagnostic stewardship, optimizing duration of therapy, promoting appropriate conversion from intravenous to oral therapy, monitoring at transitions of care and hospital discharge, implementing stewardship initiatives in the outpatient setting, and increasing use of telemedicine are approaches being adopted across hospital settings. As a core function for medical facilities, ASP leaders must ensure that antibiotic use and ASP interventions promote optimal and equitable care. The urgency of success becomes progressively greater as complex patterns of antibiotic resistance continue to emerge, exacerbated by unpredictable factors such as a worldwide pandemic.

It’s about the patients: Practical antibiotic stewardship in outpatient settings in the United States

“…Regardless of the treatment setting where it is implemented, antibiotic stewardship is an evolving field ( 82 , 83 ). Community prescribers can help move the needle on antibiotic stewardship by keeping in mind the “4 Ds”: prescribe an antibiotic for a bacterial infectious Disease, with the appropriate Drug, Dose, and Duration.…”

Antimicrobial resistance in the United States: Origins and future directions

“…The Joint Commission mandated an antibiotic stewardship requirement in outpatient settings in 2020 [ 44 ]. Barlam et al estimated 89% of hospitals implemented all seven CDC Core Elements by 2019 [ 45 ]. However, the feasibility of solutions proposed in these initiatives requires further analysis.…”

“…Antibiotic stewardship priorities include improvement of diagnostic tools, evidence-based standardization of antibiotic selection and treatment duration, enhanced data monitoring at care transitions such as hospital discharge, and creation of annual antibiograms [ 2 , 45 , 46 ]. Equally important to stewardship and infection prevention are basic cleanliness practices, such as hand washing, proper donning of PPE, and disinfection of healthcare tools and devices [ 13 ].…”

Leveraging antimicrobial stewardship programs in response to the coronavirus disease 2019 (COVID-19) public health emergency

“…The sheer volume of critically ill and dying patients during the early phases of the pandemic may have also affected the success of antimicrobial stewardship interventions. 43 Despite the numerous challenges, it is also important to acknowledge the potential benefits of the pandemic to ASPs. Published data suggest that the pandemic accelerated use of technology as part of some ASPs.…”