Experts define global criteria for hospital programs to tackle antimicrobial resistance

Infection specialists at hospitals are introducing so-called antimicrobial stewardship (AMS) programmes to use antimicrobial drug therapies more responsibly. Such programmes include a coherent set of actions which promote using antimicrobials in ways that ensure sustainable access to effective therapy for all who need them. A group of international experts, led by researchers from the Center for Disease Dynamics, Economics & Policy (CDDEP) in India and the Université de Lorraine in France, has now for the first time defined a standardized set of actions that are relevant for all hospitals around the world to preserve the effectiveness of antimicrobials and limit the emergence of antimicrobial resistance.

The group of international experts selected seven core elements and 29 related checklist items that describe the essential and minimum standards for hospital-based AMS programmes applicable in both high and low-to-middle income countries. The core elements include senior hospital management leadership towards antimicrobial stewardship, accountability and responsibilities, available expertise on infection management, education and practical training. They also include other actions aiming at responsible antimicrobial use, monitoring and surveillance as well as reporting and feedback on a continuous basis.

The current absence of a universal definition for AMS impedes the implementation of such AMS programmes globally, especially in low- and middle-income countries, explains Prof. Céline Pulcini, a professor of infectious diseases in Nancy University Hospital and University of Lorraine, France, who is also secretary of the European Society of Clinical Microbiology and Infectious Diseases' (ESCMID) Study Group for Antimicrobial Stewardship (ESGAP).

"We hope this work will be useful to those who develop national stewardship guidelines in their respective countries," Prof. Pulcini said, adding "that such core elements can also help effectively monitor the implementation of antimicrobial stewardship programmes in hospitals. This is a consensus that is applicable around the world and not just in high-income countries. Antimicrobial resistance is a global problem that needs global solutions, for the benefit of the patients and the greater good. All hospitals should be able to implement a set of essential AMS strategies."

While the resulting list resembles that of the Centers of Diseases Control and Prevention (CDC) of the United States in some points, this new consensus document is more comprehensive and more generic, and is relevant to hospital settings in low and middle-income countries. In addition, the list can be further modified and used for certification, benchmarking, or performance purposes.

The expert panel involved in this work consisted of an international group of 15 specialists from 13 countries on six continents. They include researchers from Argentina, Australia, Belgium, Brazil, China, India, Kenya, Netherlands, South Africa, Switzerland, Thailand, United Kingdom, and the United States, all with hands-on experience of AMS in low and middle-income countries.