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Improving Antimicrobial Stewardship The Evolution of Programmatic Strategies and Barriers

  • Birgir Johannsson (a1), Susan E. Beekmann (a1), Arjun Srinivasan (a2), Adam L. Hersh (a3), Ramanan Laxminarayan (a4), Philip M. Polgreen (a1) (a5) and on behalf of The Infectious Diseases Society of America Emerging Infections Network...



To describe the prevalence and characteristics of antimicrobial stewardship programs (ASPs) in hospitals across the United States and to describe financial support provided for these programs.


Electronic and paper 14-question survey of infectious diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN).


All 1,044 IDSA EIN members who care for adult patients were invited to participate.


Five hundred twenty-two (50%) members responded. Seventy-three percent of respondents reported that their institutions had or were planning an ASP, compared with 50% reporting the same thing in an EIN survey 10 years before. A shift was noted from formulary restriction alone to use of a set of tailored strategies designed to provide information and feedback to prescribers, particularly in community hospitals. Lack of funding and lack of personnel were reported as major barriers to implementing a program. Fifty-two percent of respondents with an ASP reported that infectious diseases physicians do not receive direct compensation for their participation in the ASP, compared with 18% 10 years ago.


The percentage of institutions reporting ASPs has increased over the last decade, although small community hospitals were least likely to have these programs. In addition, ASP strategies have shifted dramatically. Lack of funding remains a key barrier for ASPs, and administrators need additional cost savings data in order to support ASPs. Interestingly, while guidelines and editorials regard compensated participation by an infectious diseases physician in these programs as critical, we found that more than half of the respondents reported no direct compensation for ASP activities.


Corresponding author

Department of Internal Medicine, SW34J General Hospital, 200 Hawkins Drive, Iowa City, Iowa 52242 (


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5th Decennial International Conference on Healthcare-Associated Infection; Atlanta, Georgia; March 2010.



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1. Maragakis, LL, Perencevich, EN, Cosgrove, SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6:751763.
2. Roberts, RR, Hota, B, Ahmad, I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis 2009;49:11751184.
3. Lipsitch, M, Samore, MH. Antimicrobial use and antimicrobial resistance: a population perspective. Emerg Infect Dis 2002;8:347354.
4. McGowan, JE Jr. Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130:165168.
5. Scheckler, WE, Bennett, JV. Antibiotic usage in seven community hospitals. JAMA 1970;213:264267.
6. Dellit, TH, Owens, RC, McGowan, JE 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.
7. The Research Committee of SHEA. Enhancing patient safety by reducing healthcare-associated infections: the role of discovery and dissemination. Infect Control Hosp Epidemiol 2010;31:118123.
8. Sunenshine, RH, Liedtke, LA, Jernigan, DB, Strausbaugh, LJ. Role of infectious diseases consultants in management of antimicrobial use in hospitals. Clin Infect Dis 2004;38:934938.
9. Executive Committee of the Infectious Diseases Society of America Emerging Infections Network. The emerging infections network: a new venture for the Infectious Diseases Society of America. Clin Infect Dis 1997;25:3436.
10. Lawton, RM, Fridkin, SK, Gaynes, RP, McGowan, JE Jr. Practices to improve antimicrobial use at 47 US hospitals: the status of the 1997 SHEA/IDSA position paper recommendations. Society for Healthcare Epidemiology of America/Infectious Diseases Society of America. Infect Control Hosp Epidemiol 2000;21:256259.
11. Weinstein, RA. Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. Emerg Infect Dis 2001;7:188192.
12. Zaoutis, TE. Antibiotic resistance: who will pay the bills? Clin Infect Dis 2009;49:11851186.
13. McGowan, JE Jr. Minimizing antimicrobial resistance: the key role of the infectious diseases physician. Clin Infect Dis 2004;38:939942.
14. McQuillen, DP, Petrak, RM, Wasserman, RB, Nahass, RG, Scull, JA, Martinelli, LP. The value of infectious diseases specialists: non-patient care activities. Clin Infect Dis 2008;47:10511063.
15. Zillich, AJ, Sutherland, JM, Wilson, SJ, et al. Antimicrobial use control measures to prevent and control antimicrobial resistance in US hospitals. Infect Control Hosp Epidemiol 2006;27:10881095.
16. Nault, V, Beaudoin, M, Thirion, DJ, Gosselin, M, Cossette, B, Va-liquette, L. Antimicrobial stewardship in acute care centres: a survey of 68 hospitals in Quebec. Can J Infect Dis Med Microbiol 2008;19:237242.
17. Pope, SD, Dellit, TH, Owens, RC, Hooton, TM. Results of survey on implementation of Infectious Diseases Society of America and Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Infect Control Hosp Epidemiol 2009;30:9798.
18. Hersh, AL, Beekmann, SE, Polgreen, PM, Zaoutis, TE, Newland, JG. Antimicrobial stewardship programs in pediatrics. Infect Control Hosp Epidemiol 2009;30:12111217.
19. Drew, RH, White, R, MacDougall, C, Hermsen, ED, Owens, RC Jr. Insights from the Society of Infectious Diseases Pharmacists on antimicrobial stewardship guidelines from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Pharmacotherapy 2009;29:593607.
20. Owens, RC Jr. Antimicrobial stewardship: concepts and strategies in the 21st century. Diagn Microbiol Infect Dis 2008;61:110128.
21. Arnold, FW, McDonald, LC, Smith, RS, Newman, D, Ramirez, JA. Improving antimicrobial use in the hospital setting by providing usage feedback to prescribing physicians. Infect Control Hosp Epidemiol 2006;27:378382.
22. Cosgrove, SE, Patel, A, Song, X, et al. Impact of different methods of feedback to clinicians after postprescription antimicrobial review based on the Centers for Disease Control and Prevention's 12 steps to prevent antimicrobial resistance among hospitalized adults. Infect Control Hosp Epidemiol 2007;28:641646.
23. Di Pentima, MC, Chan, S. Impact of antimicrobial stewardship program on vancomycin use in a pediatric teaching hospital. Pediatr Infect Dis J 2010;29:707711.
24. Agwu, AL, Lee, CK, Jain, SK, et al. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008;47:747753.
25. John, JF Jr., Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471485.
26. Bannan, A, Buono, E, McLaws, ML, Gottlieb, T. A survey of medical staff attitudes to an antibiotic approval and stewardship programme. Intern Med J 2009;39:662668.
27. Wright, SB, Ostrowsky, B, Fishman, N, Deloney, VM, Mermel, L, Perl, TM. Expanding roles of healthcare epidemiology and infection control in spite of limited resources and compensation. Infect Control Hosp Epidemiol 2010;31:127132.
28. Frank, MO, Batteiger, BE, Sorensen, SJ, et al. Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clin Perform Qual Health Care 1997;5:180188.
29. Fraser, GL, Stogsdill, P, Dickens, JD Jr, Wennberg, DE, Smith, RP Jr, Prato, BS. Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1997;157:16891694.
30. Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GA, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289295.
31. Ng, CK, Wu, TC, Chan, WM, et al. Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong. Qual Saf Health Care 2008;17:387392.
32. Kuntz, JL, Cavanaugh, JE, Becker, LK, et al. Clostridium difficile-associated disease in patients in a small rural hospital. Infect Control Hosp Epidemiol 2007;28:12361239.
33. Sintchenko, V, Coiera, E, Gilbert, GL. Decision support systems for antibiotic prescribing. Curr Opin Infect Dis 2008;21:573579.
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Infection Control & Hospital Epidemiology
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  • EISSN: 1559-6834
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