Antimicrobial stewardship programs are coordinated programs within a health care setting that promote the appropriate use of antimicrobials, thereby improving patient outcomes, reducing antibiotic resistance, and decreasing the spread of infections caused by antibiotic-resistant organisms.
AHRQ's work on antimicrobial stewardship programs is part of the broad national effort to maintain the effectiveness and safety of the Nation’s antibiotics. They are an important part of the White House’s National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB).
AHRQ has developed tools, research, and resources to improve the use of antibiotics through antimicrobial stewardship programs.
Nursing Home Antimicrobial Stewardship Guide
AHRQ's Nursing Home Antimicrobial Stewardship Guide is a research-based resource that offers materials to help nursing homes improve antibiotic use and decrease harms caused by inappropriate prescribing. The guide is customizable to meet facilities' needs and includes four toolkits:
- Toolkit To Implement, Monitor, and Sustain an Antimicrobial Stewardship Program: This toolkit uses collaborative and evidence-based approaches to improve antibiotic use by getting residents the right antibiotics when they need them.
- Toolkit To Determine Whether It Is Necessary To Treat a Potential Infection With Antibiotics: This toolkit improves antibiotic use for four infections common in nursing homes: urinary tract infections, lower respiratory infections, skin and soft tissue infections, and gastrointestinal infections.
- Toolkit To Help Prescribing Clinicians Choose the Right Antibiotic for Treating an Infection: This toolkit helps nursing homes establish the use of an antibiogram, a tool used to document the strains of bacteria present in cultures and the antibiotic susceptibility of those bacteria. Prescribing clinicians can use an antibiogram to help them choose the most appropriate antibiotic for each infection.
- Toolkit To Educate and Engage Residents and Family Members: This toolkit helps residents and their family members understand what the nursing home is doing to make sure antibiotics are used properly, what the risks of taking antibiotics are, and what they can do to be engaged in decisions about their care.
Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship
This toolkit assists hospital staff and leadership in developing an effective antimicrobial stewardship program with the potential to reduce Clostridium difficile (C. difficile).
Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter-Associated Asymptomatic Bacteriuria. This study shows that a multifaceted intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of asymptomatic bacteriuria compared with standard quality improvement methods. The impact was more pronounced in long-term care.
Developing Capacity to Implement Antimicrobial Stewardship: Opportunities for the Future. This study found that using limited case-control methods for antibiotic selection was a feasible, practical, and acceptable approach for facilities to identify potential antibiotic targets for antimicrobial stewardship programs.
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Volume 4 - Antibiotic Prescribing Behavior. This report concludes that quality improvement efforts appear generally effective at reducing both inappropriate treatment with antibiotics and inappropriate selection of antibiotics. While no single quality improvement strategy was more effective than others, active clinician education may be more effective than passive education, particularly for addressing the antibiotic treatment decision.
Antimicrobial stewardship: another focus for patient safety? This review summarizes the literature on antimicrobial stewardship to illustrate its relationship with patient safety. Interventions to reduce unnecessary antibiotic use included guidelines for controlling Clostridium difficile infection rates, mandatory outpatient parenteral therapy consultations, and performing medication reconciliation.
AHRQ's Innovations Exchange features several innovations on antimicrobial stewardship.
- Antimicrobial Stewardship Toolkit
- State Health Department Support Spurs Development of Many Antimicrobial Stewardship Programs After Passage of Legislative Mandate
- Telemedicine-Based Antimicrobial Stewardship Program Improves Prescribing, Reduces Bacterial Resistance to Antibiotics at Rural Hospital
AHRQ Safety Program for Improving Antibiotic Use
This project aims to help clinicians in hospitals, doctors' offices, and long-term care apply the Comprehensive Unit-based Safety Program (CUSP) method to improve antibiotic stewardship by selecting the optimal antibiotic regimens, routes of administration, and durations. Tools, resources, and lessons learned by the facilities that are participating in this 5-year project will be compiled into a toolkit, allowing other facilities to improve antibiotic stewardship.