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Antimicrobial Stewardship—the State of the Art in 2011 Focus on Outcome and Methods

  • John E. McGowan (a1)

Antimicrobial stewardship programs attempt to optimize prescribing of these drugs to benefit both current and future patients. Recent regulatory and other incentives have led to widespread adoption of such programs. Measurements of the success of these programs have focused primarily on process measures. However, evaluation of outcome measures will be needed to ensure sustainability of these efforts. Outcome efforts to date provide some evidence for improved care of individual patients, some evidence for minimizing emergence of resistance, and ample evidence for cost reduction. Attention to evaluation methods must be increased to provide convincing evidence for the continuation of such programs.

Corresponding author
Department of Epidemiology (3041 CNR), Rollins School of Public Health of Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 (
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1.JE McGowan Jr, M Finland . Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974; 130:165168.

2.JR Hampton . The end of clinical freedom. Br Med J (Clin Res Ed) 1983;287:12371238.

3.D Marchaim , T Chopra , JM Pogue , et al.Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Anrímicrob Agents Chemother 2011; 55:593599.

5.R Wise . The urgent need for new antibacterial agents. J Anti-microb Chemother 2011;66:19391940.

6.JG Bartlett . A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011;53(suppl 1):S4S7.

7.YX Liew , W Lee , AL Kwa , DC Lye , CL Yeo , LY Hsu . Inappropriate carbapenem use in Singapore public hospitals: opportunities for antimicrobial stewardship. Int J Antimicrob Agents 2011;37:8788.

8.TC Jenkins , AL Sabel , EE Sarcone , CS Price , PS Mehler , WJ Burman . Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship. Clin Infect Dis 2010;51:895903.

9.J Carlet , P Collignon , D Goldmann , et al.Society's failure to protect a precious resource: antibiotics. Lancet 2011;378:369371.

10.PD Tamma , SE Cosgrove . Antimicrobial stewardship. Infect Dis Clin North Am 2011;25:245260.

11.CA Ohl , VP Luther . Antimicrobial stewardship for inpatient facilities, f Hosp Med 2011;6(suppl 1):S4S15.

13.DB Reuben , CK Cassel . Physician stewardship of health care in an era of finite resources. JAMA 2011;306:430431.

16.EJ Septimus , RC Owens Jr. Need and potential of antimicrobial stewardship in community hospitals. Clin Infect Dis 2011; 53(suppl 1):S8S14.

17.D Nathwani , J Sneddon , W Malcolm , et al.Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents 2011;38:1626.

18.P Davey , J Sneddon , D Nathwani . Overview of strategies for overcoming the challenge of antimicrobial resistance. Expert Rev Clin Pharmacol 2010;3:667686.

19.K Thakkar , M Gilchrist , E Dickinson , J Benn , BD Franklin , A Jacklin . A quality improvement programme to increase compliance with an anti-infective prescribing policy. J Antimicrob Chemother 2011;66:19161920.

20.NR Toth , RM Chambers , SL Davis . Implementation of a care bundle for antimicrobial stewardship. Am J Health Syst Pharm 2010;67:746749.

21.AR White . Effective antibacterials: at what cost? the economics of antibacterial resistance and its control. J Antimicrob Chemother 2011;66:19481953.

23.TH Dellit , RC Owens , JE McGowan Jr, et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.

25.JT Jacob , RP Gaynes . Emerging trends in antibiotic use in US hospitals: quality, quantification and stewardship. Expert Rev Anti Infect Ther 2010;8:893902.

26.CA Ohl , Dodds ES Ashley . Antimicrobial stewardship programs in community hospitals: the evidence base and case studies. Clin Infect Dis 2011;53(suppl 1):S23S28.

28.N Fishman . Antimicrobial stewardship. Am J Med 2006;119: S53S61; discussion S62-S70.

29.L Valiquette , B Cossette , MP Garant , H Diab , J Pepin . Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium dijd/e-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007; 45(suppl 2):S112S121.

30.AC White Jr, RL Atmar , J Wilson , TR Cate , CE Stager , SB Greenberg . Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230239.

31.TN Gandhi , DD DePestel , CD Collins , J Nagel , LL Washer . Managing antimicrobial resistance in intensive care units. Crit Care Med 2010;38:S315S323.

32.M Paul , S Andreassen , E Tacconelli , et al.Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial. J Antimicrob Chemother 2006;58:12381245.

33.M Paul , V Shani , E Muchtar , G Kariv , E Robenshtok , L Leibovici . Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 2010;54:48514863.

34.EJ Joo , CI Kang , YE Ha , et al.Impact of inappropriate empiric antimicrobial therapy on outcome in Pseudomonas aeruginosa bacteraemia: a stratified analysis according to sites of infection. Infection 2011;39:309318.

35.R Kaki , M Elligsen , S Walker , A Simor , L Palmay , N Daneman . Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:12231230.

36.MJ Talpaert , G Gopal Rao , BS Cooper , P Wade . Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 2011;66:21682174.

37.CH Chiu , IC Michelow , J Cronin , SA Ringer , TG Ferris , KM Puopolo . Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit. Pediatr Infect Dis J 2011;30:273278.

38.I Willemsen , A Groenhuijzen , D Bogaers , A Stuurman , P van Keulen , J Kluytmans . Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother 2007;51:864867.

42.P Charbonneau , JJ Parienti , P Thibon , et al.Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi experimental study. Clin Infect Dis 2006;42:778784.

44.JA Troughton , G Millar , ET Smyth , L Doherty , R McMullan . Ciprofloxacin use and susceptibility of gram-negative organisms to quinolone and non-quinolone antibiotics. J Antimicrob Chemother 2011;66:21522158.

45.PP Cook , S Rizzo , M Gooch , M Jordan , X Fang , S Hudson . Sustained reduction in antimicrobial use and decrease in methicillin-resistant Staphylococcus aureus and Clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital. J Antimicrob Chemother 2011;66:205209.

46.JE McGowan Jr. Economic impact of antimicrobial resistance. Emerg Infect Dis 2001;7:286292.

49.FJ Cooke , AH Holmes . The missing care bundle: antibiotic prescribing in hospitals. Int J Antimicrob Agents 2007;30:2529.

50.MJ Dortch , SB Fleming , RM Kauffmann , LA Dossett , TR Talbot , AK May . Infection reduction strategies including antibiotic stewardship protocols in surgical and trauma intensive care units are associated with reduced resistant gram-negative healthcare-associated infections. Surg Infect (Larchmt) 2011;12:1525.

51.PS Barie . SCIP to the loo? Surg Infect (Larchmt) 2011; 12:161162.

52.AD Harris , JC McGregor , JP Furuno . What infection control interventions should be undertaken to control multidrug-resis-tant gram-negative bacteria? Clin Infect Dis 2006;43(suppl 2): S57S61.

53.L Citrome . Number needed to treat: what it is and what it isn't, and why every clinician should know how to calculate it. J Clin Psychiatry 2011;72:412413.

54.CL Martins , ML Garly , C Bale , et al.Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial. BMJ 2008;337:a661.

55.M Haber , BR Levin , P Kramarz . Antibiotic control of antibiotic resistance in hospitals: a simulation study. BMC Infect Dis 2010; 10:254.

56.N Vernaz , B Huttner , D Muscionico , et al.Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community. J Antimicrob Chemother 2011;66:928935.

57.G Regev-Yochay , M Raz , R Dagan , et al.Reduction in antibiotic use following a cluster randomized controlled multifaceted intervention: the Israeli judicious antibiotic prescription study. Clin Infect Dis 2011;53:3341.

59.AC Achhra , P Phanuphak , J Amin . Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries. Curr Opin HIV AIDS 2011; 6:258265.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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