Infection Control & Hospital Epidemiology (2018), 39, 1237–1245 doi:10.1017/ice.2018.188
Review
Antimicrobial stewardship for acute-care hospitals: An Asian perspective
Anucha Apisarnthanarak MD1, Andrea Lay-Hoon Kwa PharmD2,3,4, Cheng-Hsun Chiu MD5, Suresh Kumar MRCP6, Le Thi Anh Thu MD, PhD7, Ban Hock Tan FRCP(UK)8, Zhiyong Zong PhD9, Yin Ching Chuang MD10,11,
Anis Karuniawati MD, PhD12,13,Maria Fe Tayzon MD14,15, Thomas Man-Kit So FRCP16 and Lance R. Peterson MD17,18 1Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand, 2Department of Pharmacy, Singapore General Hospital, Singapore, 3Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, 4Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, 5Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, 6Department of Medicine, Hospital Sungai Buloh, Sungai Buloh, Malaysia, 7Department of Infection Control, Cho Ray Hospital, Ho Chi Minh City, Vietnam, 8Department Infectious Diseases, Singapore General Hospital, Singapore, 9Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China, 10Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan, Taiwan, 11Department of Medical Research, Chi Mei Medical
Center, Tainan, Taiwan, 12Department of Microbiology, Faculty of Medicine, Universitas Indonesia, 13Cipto Mangunkusumo Hospital, Jakarta, Indonesia, 14Hospital Infection Control and Epidemiology Center, The Medical City, Pasig City, Philippines, 15Ateneo School of Medicine and Public Health, Manila,
Philippines, 16Infectious disease specialist in private practice, Hong Kong, 17NorthShore University Health System, Evanston, Illinois, United States and 18University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States.
Abstract
Inappropriate use of antibiotics is contributing to a serious antimicrobial resistance problem in Asian hospitals. Despite resource constraints in the region, all Asian hospitals should implement antimicrobial stewardship (AMS) programs to optimize antibiotic treatment, improve patient outcomes, and minimize antimicrobial resistance. This document describes a consensus statement from a panel of regional experts to help multidisciplinary AMS teams design programs that suit the needs and resources of their hospitals. In general, AMS teams must decide on appropriate interventions (eg, prospective audit and/or formulary restriction) for their hospital, focusing on the most misused antibiotics and problematic multidrug-resistant organisms. This focus is likely to include carbapenem use with the goal to reduce carbapenem-resistant gram-negative bacteria. Rather than initially trying to introduce a comprehensive, hospital-wide AMS program, it would be practical to begin by pilot testing a simple program based on 1 achievable core intervention for the hospital. AMS team members must work together to determine the most suitable AMS interventions to implement in their hospitals and how best to put them into practice. Continuous monitoring and feedback of outcomes to the AMS teams, hospital administration, and prescribers will enhance sustainability of the AMS programs.
(Received 29 June 2018; accepted 11 July 2018) Background
Antimicrobial resistance (AMR) has long been recognized as a major global health threat,1,2 and it is now a particularly urgent issue in the Asia-Pacific region.2–5 Indiscriminate use of antibiotics drives the rapid rate at which AMR is developing in this region.2,6,7 Antimicrobial stewardship (AMS) is a coordinated set of inter-
ventions designed to improve the appropriate use of antimicrobial agents by optimizing antimicrobial selection, dosage, duration of treatment, and route of administration.8 Although effective hospital AMS programs and infection control are essential to reducing the threat of AMR,8 the implementation of AMS programs has been
Author for correspondence: Anucha Apisarnthanarak, Division of Infectious Dis-
eases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand 12120. E-mail:
anapisarn@yahoo.com
Cite this article: Apisarnthanarak A, et al. (2018). Antimicrobial stewardship for
acute-care hospitals: An Asian perspective. Infection Control & Hospital Epidemiology 2018, 39, 1237–1245. doi: 10.1017/ice.2018.188
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
inconsistent across countries and regions and is often inadequate in low- and middle-income economies common in Asia.9–13 International guidelines provide evidence-based recommen-
dations for the implementation of a broad range of AMS inter- ventions.8,14,15 However, these guidelines are often incompatible with the practice and the infrastructure of many hospitals in Asia.10,12,13,15 To guide the implementation of AMS programs in acute-care hospitals across Asia, a panel of regional experts developed a consensus statement that is the basis for this docu- ment. The goal is to provide practical, flexible recommendations for implementing AMS programs designed to suit the varying clinical needs and resources of hospitals across the region.
Consensus statement methods Consensus generation
In November 2016, a panel of 11 expert infectious disease (ID) clinicians, researchers, and opinion leaders from Asia met to
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