Treating infections. Protecting patients. Combating and preventing antibiotic resistance. To achieve these goals, health leaders worldwide are driving the adoption of antibiotic stewardship programs that help clinicians improve the way they prescribe antibiotics. The result is not just reduced antibiotic resistance but also better clinical outcomes.1,2
First introduced in 2014 by the Centers for Disease Control and Prevention (CDC), the Core Elements of Hospital Antibiotic Stewardship Programs were updated in 2019 to incorporate new evidence and learnings across seven key areas: hospital leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education.
While these elements are applicable in all hospitals, regardless of size, there is no single template for an antibiotic stewardship program that leads to optimal antibiotic prescribing. Programs are expected to be customized due to the complex medical decision-making surrounding antibiotic use and the differences in hospital size and care. But no matter what each hospital’s approach looks like, an effective antibiotic stewardship program is always attainable with the right mix of support, leadership, and commitment.
The CDC’s Core Elements highlight the importance of teamwork in an antibiotic stewardship program. Implementing a hospital-wide antibiotic stewardship program requires building a core team whose members have clearly defined expectations, as well as putting in place a critical support network. Here’s how to do it.
Appoint a core team responsible and accountable for the program management and outcome. The composition of this team will depend on the resources available at each hospital, as not every role will be available in all hospitals. As the British Society for Antimicrobial Chemotherapy points out, the team should comprise at least one infectious disease physician, a clinical microbiologist, and a clinical pharmacist.6
Figure 10: Members of an ABS team (adapted from BSAC. Antimicrobial Stewardship: From Principles to Practice - eBook 2018)4
It’s especially important to engage hospitalists because they are among the largest groups of prescribers of antibiotics in hospitals.5 They also often have experience with quality-improvement work.7,8
Set the expectation that on a daily basis, the team will be responsible for the following antibiotic stewardship activities:
While putting together a team takes time, it’s not the only hurdle a hospital may face. Getting buy-in is key to successful implementation. It is vital that all clinicians are fully engaged in and supportive of efforts to improve antibiotic use. Hospital leadership can help ensure other groups and departments are aware of antibiotic stewardship efforts and facilitate collaboration.
Antibiotic stewardship programs are greatly enhanced by support from the following groups:5
The CDC's Core Elements of hospital antibiotic stewardship programs5
The CDC outlines seven core elements that provide basic framework for a successful antibiotic stewardship program.
Hospital Leadership Commitment
Dedicate necessary human, financial, and information technology resources.
Appoint a leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.
Appoint a pharmacist, ideally as the co-leader of the stewardship program, to lead implementation efforts to improve antibiotic use.
Implement interventions, such as prospective audit and feedback or pre-authorization, to improve antibiotic use.
Monitor antibiotic prescribing, impact of interventions, and other important outcomes such as C. diff infection and resistance patterns.
Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
Educate prescribers, pharmacists, and nurses about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
Adopting an antibiotic stewardship program starts with knowing the CDC’s Core Elements and engaging the right people. But it can only succeed with the ongoing dedication of all participants—in the core team and across the organization.