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Antimicrobial Stewardship

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Key Points ÎOptimizing antimicrobial therapy minimizes antimicrobial resistance and adverse drug reactions. ÎIn one large cohort study of hospitalized patients, antimicrobials were the second most common cause of adverse events. ÎIn another study, antimicrobials were the class most frequently associated with prescribing errors. ÎMany antimicrobials have been associated with superinfection due to Clostridium difficile, causing morbidity ranging from diarrhea to life threatening colitis. ÎA properly framed discussion regarding implementation of a program must present usage and resistance data specific to the hospital, unit, and patient population in addition to the general issues of antimicrobial resistance. ÎThe main responsibility for an antimicrobial stewardship program rests on physicians and pharmacists. ÎAntimicrobial stewardship must operate 24/7 to be effective. ÎEducational activities are integral to successful antimicrobial stewardship – both its clinical and administrative aspects. > A public-access web site is an excellent way to accomplish this. ÎActive auditing of prescribing practices is essential for determining the needs and targets of intervention. ÎIt is highly unlikely that any antimicrobial stewardship effort could be effective in the absence of information technology support. ÎAn adequate, institution-appropriate budget including personnel compensation is necessary for a successful program. ÎRecent payment rules from the Centers for Medicare and Medicaid Services specify that hospitals will no longer be reimbursed for certain nosocomial infections that are perceived to be avoidable. Other third-party payers are likely to follow suit. ÎRestriction of selected agents is often difficult to implement: > entirely unavailable (formulary-based restriction) > available for only certain indications (criteria-based restriction) > available only after approval by some authority (preauthorization-based restriction)

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