Dr.sherin elsherbiny Senior registrar clinical microbiology AMR coordinator Infection control auditor Riyadh region Meeqat General Hospital ,Madina,KSA

1. Antibiotic stewardship
Dr.sherin elsherbiny
Senior registrar clinical microbiology
AMR coordinator
Infection control auditor
Riyadh region

2. 2
Antimicrobial Resistance: a growing
problem
• In 2004, approximately 2 million people
experienced a hospital-acquired infection
• 90,000 of these infections were fatal
• 1 death every six minutes
Dellit TH. Clin Infect Dis 2007 Jan 15;44(2):159

3. Antimicrobial Development
3
Trends In Microbiology. 2014;22(4):165-167.

5. How Antibiotic Resistance
Happens
CDC, Antibiotic resistance threats in the United States, 2013

6. Antimicrobial Prescribing Facts:
The 30% Rule
➤ 30% of all hospitalized inpatients receive antibiotics
➤ Over 30% of antibiotics are prescribed inappropriately
➤ Up to 30% of all surgical prophylaxis is inappropriate
➤ 30% of hospital pharmacy costs are due to antimicrobial use
➤ 10-30% of pharmacy costs can be saved by antimicrobial
stewardship programs
[Hoffman et al., 2007; Wise et al., 1999; John et al., 1997]

7. 7
What is:
Antimicrobial Stewardship

8. Antimicrobial Stewardship
 Strategic multidisciplinary and facility
specific efforts to optimize antimicrobial
prescribing
 It is commitment to always use antibiotics
appropriately and safely
 Right drug
 Right dose
 Right duration
 Recognize when not needed

9. Objectives
 Maximum antimicrobial benefit
 Avoid harm from adverse reactions and
drug allergies
 Improve patient outcomes
 Decrease antimicrobial resistance
 Decrease healthcare costs

10. Stewardship Program Functions
 Develop guidelines, policies, and protocols
that support optimal prescribing
 Prioritize efforts
 Specific conditions
 Particular units or prescriber groups
 Specific antimicrobial drugs
 Educate
 Monitor and report

11. Core Elements of Antimicrobial
Stewardship Programs
 Leadership Commitment
 Accountability
 Drug Expertise
 Action
 Tracking
 Reporting
 Education

12. Leadership Commitment
 Leadership support for efforts to improve and
monitor antibiotic prescribing
 Assurance that involved staff has time, authority,
and accountability

13. Accountability
 Stewardship program leader:
 Identify a single leader who will be responsible for
program outcomes
 Physicians and/or pharmacists can be highly
effective in this role

14. Drug Expertise
 Identify a pharmacist to be involved
 Formal training in infectious diseases and/or
antibiotic stewardship is beneficial
 Pharmacist can assist in
 Identifying areas for improvement, and
 Monitoring use

15. Pharmacy-driven Interventions
 Automatic changes from intravenous to oral
antibiotic therapy
 Automatic alerts in situations where therapy might
be unnecessarily duplicative
 Dose adjustments/optimization
 Time-sensitive automatic stop orders

16. Action: Guidelines
 Facility-specific guidelines, based on
 National guidelines
 Local susceptibility
 Select and review charts
 What is current practice?
 What can we improve upon?
 Involve prescribers

17. Actions: Interventions
 Guidelines, policies, and protocols alone will
probably not change practice
 Active interventions are most effective
 Prospective audit
 Formulary restriction and preauthorization
 Antibiotic ‘Time Out’

18. Additional Core Elements
Tracking:
 Monitoring antibiotic prescribing and resistance
patterns
Reporting:
 Regular reporting information on antibiotic use and
resistance to doctors, nurses and relevant staff
Education:
 Educating clinicians about resistance and optimal
prescribing

19. Two core ASP strategies
have emerged
➤ “Front–end strategies” where antimicrobials are made
available through an approval process (formulary
restrictions and preauthorization).
➤ “Back-end“ strategies are where antimicrobials are
reviewed after antimicrobial therapy has been initiated
(prospective audit with intervention and feedback)

20. Prospective Audit
 An physician or pharmacist reviews orders
and intervenes with modification of order
and feedback to prescriber
 Results in improved use, decreased costs
 Limitations :

21. Key Supporters
 Clinician groups
 Infection preventionists
 Quality improvement staff
 Laboratory staff
 Nurses

22. Moving Stewardship to the Front Lines
 Every practitioner should embrace the
responsibility to optimize antibiotic use
 Starting point: Identify specific interventions
that people can do to improve antibiotic use

23. 23Centers for Disease Control and Prevention (CDC) 12 steps to prevent antimicrobial
resistance. http://www.cdc.gov/drugresistance/healthcare/ha/HASlideSet.pdf

24. 24
Health care professionals are
already playing
with antimicrobials