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Antimicrobial Stewardship in Australian Hospitals and Other Settings
#MMPMID26362294
Cairns KA
; Roberts JA
; Cotta MO
; Cheng AC
Infect Dis Ther
2015[Sep]; 4
(Suppl 1
): 27-38
PMID26362294
show ga
Australia's model of antimicrobial stewardship (AMS) has evolved significantly
over recent years, from a long-standing national approach of antimicrobial
prescribing guidelines and antimicrobial prescribing restrictions to recent
advances including the first National Antimicrobial Resistance Strategy and
incorporating mandatory AMS as part of hospital accreditation standards. AMS
programs are most commonly found in the hospital setting. Various models are used
throughout the country based on the local context and resources available.
Programs implemented at Alfred Health and the Royal Brisbane and Women's Hospital
represent two successful models in tertiary referral settings that accommodate a
general ward setting as well as specialized areas with a high infection burden.
Measurement of outcomes related to AMS activities remains poorly standardized,
with process indicators such as antimicrobial utilization forming a large
proportion of outcome measurement. Presently there is no requirement for any AMS
outcome measurements to be reported externally. Point prevalence surveys of
appropriateness of prescribing and compliance with prescribing guidelines are
widely used at a national level. Despite this, there is still a paucity of
published Australian data to support the effect of AMS on patient clinical
outcomes. Private hospitals, the community, veterinary medicine and aged care
sectors represent an important area for future AMS expansion within Australia.
The AMS focus has traditionally been on prescribing restrictions (through the
Commonwealth funding agencies); however, recent work has described other areas
for improvement and development in both settings. AMS in Australia continues to
evolve. The recent development of an Australian strategic plan to link
antimicrobial utilization and resistance surveillance with policy represents an
important step forward for the future of AMS in Australia.
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