This power point briefly describe definition, importance, core elements, principle hospital implementations and gaps of antimicrobial stewardship. In addition some recommendations are also mentioned.

1. College of Health Sciences
School of Medicine
Department of Medical Microbiology, Parasitology
and Immunology
Course Title: Advanced Bacteriology
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2. By: Gemechis Dejene
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3. Outline
• Introduction
• Objectives of Antibiotic stewardship
• Core elements
• Principles
• Implementations
• Barriers
• Conclusion
• Recommendations
• References
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4. Introduction
 Antibiotics are chemical substances that kill or inhibit bacterial growth
 Antibiotic resistance occurs when bacteria change in response to the use
of these medicines.
 Antibiotic resistance in bacteria develops naturally. [1]
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5. Introduction…
 Inappropriate use of antibiotics has exacerbated antibiotics resistance:
 Prescribing antibiotics unnecessarily,
 Using broad-spectrum antibiotics when narrow-spectrum agents are
sufficient,
 Prescribing antibiotics for viral infections, and
 Continuing antibiotics for too long
 Use of antibiotics in foods [2]
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6. Introduction…
 AMR has an impact on patient care, regional and international economy.
 MDR bacterial infections require longer and more expensive treatment.
 According to the estimates by the WHO, 700,000 deaths are attributable
to AMR each year globally
 It has been estimated that 10 million people could die from resistant
bacterial infections annually worldwide by 2050, if AMR is not
suppressed. [2, 4]
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7. Introduction…
 In Africa and Asia, the annual total death is expected to reach 4,150,000
and 4,700,000 respectively.
 To address this problem, the concept of antibiotic stewardship was
introduced in the 1990s
[4,5]
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8. Objectives of antibiotics Stewardship
Antibiotic stewardship programs have several objectives:
Optimizing Patient Outcomes
Reducing the Development of Antibiotic Resistance
Reducing Healthcare Costs
Promoting Public Health
Improving Antibiotic Prescribing Practice and Education of Healthcare Providers
Achieving ASP objectives, have a significant impact on patient outcomes,
resistance patterns of bacteria, healthcare costs and promoting public
health. [6]
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9. Core elements of antibiotics Stewardship
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10. Principles of Antibiotic Stewardship
The principles of antibiotic stewardship involve promoting the wise use
of antibiotics to optimize patient outcomes while minimizing the
development and spread of antibiotic-resistant bacteria.
 Appropriate Antibiotic Prescribing
 Education and Communication
 Monitoring and Tracking
[8]
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11. Principle…
 Patient and Public Education
 Antibiotic Selection and Formulary Management
 Preventing Transmission of Infections
[8]
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12. Implementation of antibiotic stewardship
Implementation of AMS programs requires a comprehensive approach
between all members of the healthcare team, managers, policymakers,
and service users. [9]
Antibiotic Stewardship program has different committees and teams:
AMS committee, AMS team, and/ or AMS champions to implement the
AMS program effectively. [6]
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13. Implementation…
i. AMS committee
 In the health-care facility the committee should provide an overall
coordination, responsible for providing leadership support and is
accountable for the overall implementation of the AMS program. [6]
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14. Implementation…
ii. AMS team
 It is a multidisciplinary team
 The AMS team should encompass a prescribing clinician, a pharmacist
or a clinical pharmacologist, a nurse, an infectious disease physician, a
microbiologist or laboratory professionals, Hospital epidemiologists, and
an Information system specialist. [6]
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15. AMS Team
a. Expertise in infection management - Director
 Infection disease specialist, or a physician with interest and experience in
infectious diseases.
 The physician often leads the AMS team
b. Expertise in antimicrobials – Co-director
 Is a Pharmacist or pharmacologist, trained in infectious disease
 Promote best practices in prescribing, dispensing and administering
antibiotics [6]
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16. AMS Team…
c. Expertise in patient care - Member
 Is typically provided by nurses
 Promote timely antibiotic administration without missing doses,
therapeutic drug monitoring, quality microbiological sampling and
communication of laboratory results to prescribers to support antibiotic
prescription decisions. [6]
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17. AMS Team…
d. Expertise in microbiology
 Provided by a microbiologist or laboratory technician to process samples
for diagnosis and AST, and to feed back the results to the prescribers
 Develop and regularly update the healthcare facility’s aggregate
antibiogram. [5,6]
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18. Barriers to antimicrobial stewardship
Some commonly encountered gaps are:
 Clinician knowledge deficits regarding the optimal use of antibiotics;
 Limited access to reliable clinical diagnostic or microbiologic testing;
 Lack of communication between health care providers;
 Limited or unreliable access to quality-assured antimicrobials; [10]
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19. Barriers…
 Limited infrastructure and/or administrative support for antimicrobial
stewardship programs or interventions;
 Limited public/patient acceptance of antimicrobial stewardship; and
• Public access to antimicrobials, antibiotics, without prescriptions in the
community [11]
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20. Conclusion
 Antibiotic resistance leads to higher medical costs, prolonged hospital
stays, and increased mortality.
 The world needs to change the way it prescribes and uses antibiotics
 AMS is about using antibiotics wisely to minimize development and
spread of antibiotic resistance.
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21. Recommendations
Awareness creation on appropriate use, and the importance of
antimicrobial stewardship program.
Healthcare facilities should adopt guidelines and treatment protocols
for the appropriate use of antibiotics.
De-escalation should be considered when appropriate
Collaboration is essential between healthcare providers, patients, and
public health authorities
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22. References
1. WHO, Antibiotic resistance, July 2020, https://www.who.int/news-room/fact-
sheets/detail/antibiotic-resistance
2. Chetty, S.; Reddy, M.; Ramsamy, Y.; Dlamini, V.C.; Reddy-Naidoo, R.; Essack, S.Y.
Antimicrobial Stewardship in Public-Sector Hospitals in KwaZulu-Natal, South
Africa. Antibiotics 2022, 11, 881. https://doi.org/10.3390/antibiotics11070881
4. A Practical Guide to Antimicrobial Stewardship Program in Ethiopian Hospitals, May
2018
5. Core Elements of Hospital Antibiotic Stewardship Programs , National Center for
Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, 2019, https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.
6. Antimicrobial stewardship programmes in health-care facilities in low- and middle-
income countries. A practical toolkit. Geneva: World Health Organization; 2019.
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