Introduction to Antimicrobial Stewardship
Antimicrobial stewardship (AMS) is a systematic approach aimed at promoting the appropriate use of antimicrobials to improve patient outcomes, reduce microbial resistance, and decrease the spread of infections caused by multidrug-resistant organisms[1].
The Importance of Antimicrobial Stewardship
AMS is crucial in the fight against antimicrobial resistance (AMR), a global health threat that can lead to untreatable infections and increased mortality rates[2]. By ensuring the judicious use of antimicrobials, AMS programs can help preserve the effectiveness of existing drugs and prolong their lifespan[3].
The Global Responsibility of Antimicrobial Stewardship
The fight against AMR is a global responsibility. Implementation of AMS needs to be carried out across the globe, and international research collaboration between developing and developed countries should be encouraged[4].
The Impact of COVID-19 on Antimicrobial Stewardship
The COVID-19 pandemic has had significant implications for AMS, with both negative impacts and unexpected opportunities arising.
The Negative Impact of the Pandemic
The pandemic has overwhelmed healthcare systems worldwide, often diverting key resources and leading to a reduction in routine AMS activities[5]. This includes audits, quality improvement initiatives, education, AMS meetings, and multidisciplinary work, including ward rounds[5].
The Positive Outcomes and Future Opportunities
Despite the challenges, the pandemic has also led to innovation and increased collaboration, which could strengthen AMS in the post-pandemic era[5]. For instance, technology has been increasingly used as a tool to facilitate stewardship, such as virtual meetings and ward rounds[5].
The Spread of Resistant Pathogens during the COVID-19 Pandemic
The COVID-19 pandemic has also significantly spread resistant pathogens among critically ill patients[6].
The Situation in Intensive Care Units
In intensive care units (ICUs), a significant spread of resistant pathogens such as carbapenem-resistant Pseudomonas aeruginosa and Candida auris has been observed among critically ill COVID-19 patients[6].
The Need for Dedicated Strategies
Given this situation, dedicated strategies are warranted to prevent the horizontal spread and maintain effective antimicrobial stewardship programs in the setting of COVID-19 care[6].
Barriers to Implementing Antimicrobial Stewardship Programs
Implementing AMS programs is not without its challenges, particularly in low- and middle-income countries.
Challenges in Low- and Middle-Income Countries
In these settings, barriers such as impaired drug availability, lack of trust in microbiologic data, and lack of local guidelines can hinder the implementation of AMS programs[7].
Potential Solutions and Steps Forward
To overcome these barriers, enhancing the availability of and trust in microbiologic data, creating local guidelines, and educating physicians regarding antimicrobial prescribing are important steps that could be taken[7].
Antimicrobial Stewardship in Solid Organ Transplant Recipients
Solid organ transplant recipients present a unique challenge for AMS due to their increased risk of infections from multidrug-resistant organisms.
The Unique Challenges in this Population
Factors such as the type of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection in this population[8]. As such, a “one-size-fits-all” stewardship style is not feasible for this patient population[8].
Opportunities for Optimizing Antimicrobial Use
Despite these challenges, this population has opportunities for optimizing antimicrobial use. Identifying risk factors and implementing ASP strategies can improve patient outcomes while reducing the risk of AMR[8].
Conclusion
Antimicrobial stewardship is a crucial component in the fight against antimicrobial resistance. Despite the challenges posed by the COVID-19 pandemic and other barriers, there are opportunities for innovation and improvement. By implementing dedicated strategies and optimizing the use of antimicrobials, it is possible to improve patient outcomes and preserve the effectiveness of existing drugs.
Disclaimer: This article is for informational purposes only and should not be taken as medical advice. Always consult with a healthcare professional before making any decisions related to medication or treatment.
Frequently Asked Questions
- What is antimicrobial stewardship?
Antimicrobial stewardship is a systematic approach aimed at promoting the appropriate use of antimicrobials to improve patient outcomes, reduce microbial resistance, and decrease the spread of infections caused by multidrug-resistant organisms. - Why is antimicrobial stewardship important?
Antimicrobial stewardship is crucial in the fight against antimicrobial resistance, a global health threat that can lead to untreatable infections and increased mortality rates. - How has the COVID-19 pandemic impacted antimicrobial stewardship?
The COVID-19 pandemic has had significant implications for antimicrobial stewardship, with both negative impacts and unexpected opportunities arising. - What are some of the challenges in implementing antimicrobial stewardship programs?
Challenges can include impaired drug availability, lack of trust in microbiologic data, and lack of local guidelines, particularly in low- and middle-income countries. - How can antimicrobial stewardship be optimized in solid organ transplant recipients?
Identifying risk factors and implementing antimicrobial stewardship program strategies can improve patient outcomes while reducing the risk of antimicrobial resistance in this population.
References
[1]: Bibliometric analysis of peer-reviewed literature on antimicrobial stewardship from 1990 to 2019. Link
[2]: Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom. Link
[3]: Spread of Carbapenem-Resistant Gram-Negatives and Candida auris during the COVID-19 Pandemic in Critically Ill Patients: One Step Back in Antimicrobial Stewardship? Link
[4]: Bibliometric analysis of peer-reviewed literature on antimicrobial stewardship from 1990 to 2019. Link
[5]: Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom. Link
[6]: Spread of Carbapenem-Resistant Gram-Negatives and Candida auris during the COVID-19 Pandemic in Critically Ill Patients: One Step Back in Antimicrobial Stewardship? Link
[7]: Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study. Link
[8]: White paper on antimicrobial stewardship in solid organ transplant recipients. Link
