If possible, a microbiologist who can prepare culture and susceptibility data to optimize antimicrobial management and conduct timely documentation of microbial pathogens should be a member of the team. Microbiologists can report organism susceptibility, assist in the surveillance of specific organisms, and provide early identification of patients with MDROs that require transmission-based precautions. The microbiologist can perform a semiannual update of a local antibiogram while reporting antimicrobial susceptibility profiles. Based on the information gathered, microbiologists can provide new drug panels to the members of the ASP, who will decide which antibiotic panel will be used. Another possible member of the ASP team is a program analyst who provides data retrieval, performs data analysis, and delivers necessary reports to the team.
It is the responsibility of medical staff to review and implement suggestions made by the ASP when appropriate. However, these suggestions are not considered a substitute for clinical decisions, and discretion is required when treating individual patients. The VHA, in response to the IDSA/SHEA published guidelines, chartered an antimicrobial stewardship task force in May 2011 with the sole purpose “To optimize the care of Veterans by developing, deploying and monitoring a national-level strategic plan for improvements in antimicrobial therapy management.” 1 In 2011, the Office of Inspector General in a combined assessment program summary report for management of MDROs in VHA facilities recommended that “the Under Secretary for Health, in conjunction with VISN and facility senior managers, ensures that facilities develop policies and programs that control and reduce antimicrobial agent use.” 13
In 2012, the VHA conducted a survey to obtain baseline data regarding ASP activities, presence of dedicated personnel, current related practice policies, available resources, and outcomes. There were 140 voluntary participating VA facilities, of which 130 had inpatient services. The survey found that 26 facilities (20%) did not have an attending ID physician, 49 facilities (38%) reported having an ASP, 19 facilities (15%) had developed policy in place addressing de-escalation of antimicrobials, 87 facilities (67%) had not developed a business plan for an ASP, and 61 facilities (47%) had completed a medication usage evaluation. 14 Feedback following the analysis of the survey data recommended integrating more ID personnel as needed, along with the development of ASP teams for all facilities with inpatient services, who would have the authority to change the antimicrobial therapy selection and have policies in place related to ASP principles.
Conclusions
Increased MDROs and decreased anti-infective development requires stricter management of antibiotics. An ASP is essential in any hospital or health care facility to decrease the incidence of resistance and improve patient care. The ASP is a collaborative effort that involves multiple specialties and departments. A successful ASP is one that changes based on local prescribing trends and resistance patterns while focusing on a patient as an individual.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.