Antimicrobial stewardship programmes: the need for wider engagement.

To cite: Charani E, Holmes AH. BMJ Qual Saf 2013;22:885–887. Antimicrobial resistance has been recognised as a major global health threat and is now on the political agenda with world leaders recognising the necessity to act to preserve the potency of antimicrobial agents and invest funds to discover new ones. Despite the majority of antimicrobial prescribing and consumption occurring in primary care settings, hospitalised populations experience the full force of antimicrobial resistance and difficult-to-treat multidrug resistant organisms. To optimise antimicrobial prescribing, reduce healthcare associated infections and minimise the emergence of antimicrobial resistance, hospitals in both developed and developing healthcare systems are increasingly implementing initiatives ranging from targeted interventions to antimicrobial stewardship programmes. 7 Antimicrobial stewardship is the umbrella term used to define comprehensive quality improvement activities that together represent a cohesive programme aiming to optimise the use of antimicrobials, improve patient outcomes, reduce the spread and development of antimicrobial resistance and reduce the incidence of healthcare acquired infections. To assist antimicrobial stewardship initiatives, governments, policy makers and researchers have attempted to draw up recommendations for optimal practice. The prevailing expectation of healthcare systems is to deliver high quality care in the face of increasing financial cuts and increasing numbers of patients treated. Therefore, a pragmatic approach to developing and implementing sustainable interventions in antimicrobial stewardship is required. The challenge of implementing antimicrobial stewardship programmes is not limited to large teaching hospitals and academic centres in the developed world and it follows that the solutions to these problems cannot be limited to them. The increasing globalisation of the world and population mobility ensures the rapid spread of new resistant organisms and infectious diseases making them shared global problems. It is therefore encouraging to see antimicrobial stewardship initiatives being implemented across the globe. 12 13