The use of antibiotics is the most important factor in the development of antimicrobial resistance. Reducing antibiotic use in a single facility has been shown to reduce resistance in that facility. Antimicrobial stewardship programs aim to measure and promote use of the appropriate agent, dose, duration, and route of administration of antimicrobial agents, in order to improve patient outcomes while minimizing toxicity and the emergence of antimicrobial resistance. Antimicrobial stewardship is essential in the control of Clostridium difficile infections and the emergence of infections due to multidrug resistant organisms, and can also reduce excessive costs attributable to inappropriate antimicrobial use.
California is the first and remains the only state to enact antimicrobial stewardship legislation. Since 2008 California law required that general acute care hospitals develop a process for monitoring the judicious use of antibiotics and that the results are monitored by quality improvement committee(s). In September 2014, California Senate Bill 1311 was signed into law, further requiring hospitals to adopt and implement an anitmicrobial stewardship policy in accordance with guidelines established by federal government and professional organizations, and to establish a physician-supervised multidiscilinary antimicrobial stewardship committee with at least one physician or pharmacist who has undergone specific training related to stewardship. Nationally, a presidential Executive Order - Combatting Antibiotic-Resistant Bacteria, also issued in September 2014, requires federal agencies to review existing regulations and propose new regulations or other actions to require hospitals to implement robust stewardship programs that adhere to best practices; agencies will also be required to define, promulgate and implement stewardship programs in other settings such as long-term care facilities and outpatient settings.
The CDPH HAI Program supports the California Antimicrobial Stewardship Program Initiative to provide consultation and education for California hospitals and other healthcare facilities to implement these important local programs. CDPH performed a statewide assessment of antimicrobial stewardship programs during May 2010-September 2011 and published findings in the The State of Antimicrobial Stewardship in California. In 2014, CDPH launched the Spotlight on Antimicrobial Stewardship Programs Project, which allows hospitals to share their antimicrobial stewardship program strategies and progress and identifies California physicians, pharmacists, and infection prevention leaders willing to serve as mentors to other hospitals in various stages of antimicrobial stewardship program implementation. The Spotlight on Antimicrobial Stewardship Program Project Invitation 2014 remains open to allow additional hospitals to participate.
California Antimicrobial Stewardship Program Initiative activities:
Use results from a statewide assessment of antimicrobial stewardship programs to provide evidence-based recommendations for implementing or strengthening antimicrobial stewardship programs depending on facility attributes and resources.
Provide consultative advice and practical evidence to facilities in order to gain administrative, pharmacy and provider buy-in.
Define activites that comprise antimicrobial stewardship programs in California hospitals.
The CDPH HAI Program California Antibiogram Project collected information on specific antimicrobial-organism combinations across California general acute care hospitals.
American Hospital Association toolkit: http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/index.shtml
CDC's Core Elements for Hospital Antibiotic Stweardship Programs and Checklist for Hospital Antibiotic Stewardship Programs.
Infectious Diseases Society of America (IDSA): http://www.idsociety.org/Antimicrobial_Agents/#Antimicrobial Stewardship
Society of Healthcare Epidemiology of America (SHEA): http://www.shea-online.org/PriorityTopics/AntimicrobialStewardship.aspx
Stanford School of Medicine: http://bugsanddrugs.stanford.edu/
Greater New York Hospital Association http://www.gnyha.org/whatwedo/quality-patient-safety/infection-control-prevention/
Depatment of Health and Human Services, Center for Medicare and Medicaid Services. "Interpretive Guidelines for Long-Term Care Facilities, Tag F441", CMS Manual System Pub. 100-07 State Operations Provider Certification, Transmittal 51, July 30, 2009.
Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) Infection Control and Hospital Epidemiology, Vol. 33, No. 4, Special Topic Issue: Antimicrobial Stewardship (April 2012), pp. 322-327 -- see recommendations
Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Health Care Epidemiologists. Julia Moody, Sara E. Cosgrove, Russell Olmsted, Edward Septimus, Kathy Aureden, Shannon Oriola, Gita Wasan Patel, and Kavita K. Trivedi. Infection Control and Hospital Epidemiology, Vol. 33, No.4, Special Topic Issue: Antimicrobial Stewardship (April 2012), pp. 328-330 -- see recommendations