ANTIMICROBIAL STEWARDSHIP: THE TOOL AGAINST THE PANDEMIC OF ANTIMICROBIAL RESISTANCE

ANTIMICROBIAL STEWARDSHIP: THE TOOL AGAINST THE PANDEMIC OF ANTIMICROBIAL RESISTANCE

?Antimicrobial resistance?(AMR) has emerged as?one?of the principal public health?problems of?the 21st century that threatens the effective prevention and treatment of an ever-increasing range of infections?caused by?bacteria, parasites, viruses and fungi no longer susceptible to the common medicines used to treat them.

??What factors lead to AMR?

The main causes of antibiotic resistance?have been linked to:

·????????Over-prescription of antibiotics

·????????Patients not finishing the entire antibiotic course

·????????Overuse of antibiotics in livestock and fish farming

·????????Poor infection control in health care settings

·????????Poor hygiene and sanitation

·????????Absence of new antibiotics being discovered

??How we can tackle this growing menace of Antimicrobial resistance(AMR)?

1. Improve awareness and understanding of antimicrobial resistance;

2. Strengthen knowledge through surveillance and research;

3. Reduce the incidence of infection;

4. Optimize the use of antimicrobial agents in health, animal and food sectors;

5. Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

6. Effective implementation of AMS in healthcare settings

??Importance of Antimicrobial stewardship(AMS):

Developing a program to properly use?antimicrobials?is essential for inpatient facilities to decrease the incidence of?resistance, reduce the development of multidrug-resistant organisms, and improve patient care.

Antimicrobial stewardship?is a coordinated program that promotes the appropriate use of?antimicrobials?(including?antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.

Antimicrobial stewardship involves optimizing antibiotic use while using cost-effective interventions to minimize antibiotic?resistance?and control Clostridium difficile.

The optimal care of an infected patient means treating with the correct, properly dosed antibiotic and one that has the least likelihood of causing collateral damage (ie, leading to resistance in the patient or his or her contacts)

To simplify, its right Drug, right Dose, De-escalation to pathogen-directed therapy, and right Duration of therapy.

??Strategies to implement AMS:

The five core strategies of AMS includes:

(i)?????????????????Formulation of an AMS team in each hospital, health district office and health clinics;

(ii)???????????????surveillance and feedback mechanism on specific antimicrobial consumption;

(iii)?????????????implementation of prospective audit and feedback according to local needs;

(iv)?????????????formalize regular antimicrobial rounds by AMS team especially in state and specialist hospitals; and

(v)???????????????establishment of formulary restriction and a pre-authorization/approval system

·????????An effective hospital-wide antimicrobial stewardship program (ASP) should be led by team of Clinical Microbiologist, Clinical pharmacist , Infectious disease (ID) physician and other key stakeholders.

? Challenges/barriers in ?implementation of AMS in healthcare settings:

The common barriers include:

·????????lack of funding

·????????lack of trained human resources

·?????????lack of information technology

·????????Lack of higher priorities

·????????lack of awareness of administration and

·????????finally last but not least is the prescriber opposition.

??What impact can nurses have on AMS?

Nurses provide 24/7 care to patient. Nurses know the latest condition and lab result. Involving nurses in HAI prevention has been a good success!

·????????Knowing how to obtain cultures properly to avoid specimen contamination

·????????Knowing when to collect cultures

·????????Knowing when cultures might not be indicated

·????????Knowing when a broad-spectrum antibiotic drug should be discontinued

·????????Administration of antibiotics

·????????Knowing how to administer antibiotics

·????????Knowing when antibiotics are started/changed

·????????Understanding potential drug interactions

·????????Knowing when intravenous therapy could be converted to oral therapy ? Knowing when culture results and/or drug levels are available

·????????Prompting providers to do antibiotic time outs and antibiotic review

·?????????Knowing when to do Antibiotic de-escalation

·????????Upon discharging: ? Patient education

??One health AMS:

One Health is the understanding that the health of humans, animals, and the environment is connected. Working across human, animal, and environmental health can help identify solutions that can improve the health of all.

One Health AMS means a collaborative, multisectoral, and trans-disciplinary approach-working at the local, regional, national and global levels with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants and their shared environment.

??How are the healthcare associated infections(HAIs) and Antimicrobial resistance related?

There is a close relationship between antibiotic resistance and health care associated infections. In fact, HAIs are often caused by resistant bacteria, but the occurrence of an infection in the first place can also increase the risk of developing resistant strains.

The rate of multiple drug-resistant organisms causing infection within our hospitals is increasing at a rapid rate. Currently, national data demonstrate that more than 50% of?Staphylococcus aureus?isolates causing infections in intensive care units (ICUs) are resistant to methicillin (MRSA), while more than 40% are resistant in other non-ICU hospital units.

Similarly, gram-negative organisms have developed resistance, with more than 25% of?Pseudomonas aeruginosa?ICU isolates now resistant to fluoroquinolones, with a much higher percentage resistant at some institutions.

??KEY MESSAGES :

·????????Antibiogram and Antibiotic utilisation review should be done at regular intervals in healthcare settings as it contributes to rational drug use, detects early signs of irrational drug use and helps in identifying interventions to improve drug use and follow up.

·????????Every Healthcare facility should have a multidisciplinary therapeutic committee which should develop a local antibiotic policy based on the antibiogram and national recommendations.

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About the Author:

Dr Rahul Kamble is currently associated with Americares India Foundation as Project Head - Antimicrobial stewardship.

His expertise includes Infectious diseases control and Antimicrobial stewardship. He has done Airborne infection control course from Harvard Medical School and Infectious Diseases Diploma from UNSW, Australia. He has been Active Member of Antimicrobial Stewardship programs for the best hospitals in India. In addition, He is an JCI & NABL internal auditor, NABH assessor and Ramkrishna Bajaj Quality award auditor with ten diplomas in Healthcare management programs along with prestigious Six sigma Black belt.