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  • Promoting Antimicrobial Stewardship in Human Medicine


    Antimicrobial stewardship refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.  Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains.  Currently, there are no national or coordinated legislative or regulatory mandates designed to optimize use of antimicrobial therapy through antimicrobial stewardship.  Given the societal value of antimicrobials and their diminishing effectiveness due to antimicrobial resistance, IDSA supports broad implementation of antimicrobial stewardship programs across all health care settings (e.g., hospitals, long-term care facilities, long-term acute care facilities, ambulatory surgical centers, dialysis centers, and private practices.

    See elsewhere, IDSA’s policy efforts related to:
    Other Aspects of Antimicrobial Resistance
    Non-Judicious Uses of Antibiotics on the Farm
    Health Care-Associated Infections and Infection Control 

    IDSA's Efforts to Promote Antimicrobial Stewardship in Human Medicine


    Antimicrobial Stewardship Policy Statement of the IDSA, SHEA and PIDS

    IDSA, SHEA, PIDS, Infection Control and Hospital Epidemiology vol. 33 no. 4 March 15, 2012 322-327.

    Joint position statement of IDSA, SHEA and PIDS outlining recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, including recommendations to monitor interventions and methods to address current deficiencies in education and research, as well as the lack of accurate data on antimicrobial use in the United States.


    IDSA Testimony on Antibiotic Resistance, delivered before the House Energy and Commerce Health Subcommittee (PDF)

    Brad Spellberg, MD, FIDSA, presented IDSA's statement at a hearing on “Promoting the Development of Antibiotics and Ensuring Judicious Use in Humans.”

    IDSA Testifies on Medical Countermeasures Enterprise Review (PDF)


    Dr. Andy Pavia testified on behalf of IDSA at a September 29, 2010 hearing of the Senate Labor-Health and Human Services-Education Appropriations Subcommittee examining the Public Health Emergency Medical Countermeasures Enterprise review recently completed by the HHS Secretary.


    IDSA and SHEA Respond to Federal Action Plan on Healthcare-Associated Infections (PDF)

    IDSA and SHEA urge increased funding, ongoing stakeholder input and development of an implementation portion of the plan in response to HHS' release of the draft "Action Plan to Prevent Healthcare-Associated Infections" in January 2009 following criticism of federal inaction.

    Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship

    IDSA and SHEA jointly published guidelines in Clinical Infectious Diseases (January 2007 vol. 44 no. 2  159-177) for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy.  The primary goal of antimicrobial stewardship is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms (such as Clostridium difficile), and the emergence of resistance.  Thus, the appropriate use of antimicrobials is an essential part of patient safety and deserves careful oversight and guidance.

    Guidelines for the Prevention of Antimicrobial Resistance in Hospitals

    Antimicrobial resistance results in increased morbidity, mortality, and costs of health care.  Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs.  Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms.  Clinical Infectious Diseases (September 25 1997 vol. 25 no. 3 584-599).

    IDSA Leads Groups in Letter to CMS on Stewardship (PDF)

    IDSA was joined by 33 other organizations in a letter to the Centers for Medicare & Medicaid Services (CMS) advocating that hospitals and long-term care facilities be required to implement an antibiotic stewardship program (ASP) as a Condition of Participation (COP) in Medicare and Medicaid.  CMS is known to be actively considering the proposal.  The recommednation was also made by the President's Council of Advisors on Science and Technology (PCAST) in their recent report on combatting antibiotic-resistant bacteria.

    IDSA Comments on Draft Antimicrobial Resistance Action Plan (PDF)

    IDSA provided comments on the draft Action Plan published by the federal Interagency Task Force on Antimicrobial Resistance highlighting the need for greater leadership, coordination, non-government expert input, accountable measures, and resources.

    IDSA Supports Removing Legal Barriers that Prohibit Incentive Payments for ID Physicians Systems-Level Activities (PDF)

    IDSA urged Medicare and the Office of Inspector General to establish waivers, safe harbors, and/or exceptions to federal anti-trust laws that would allow gainsharing payments for systems-level activities, such as infection control and antimicrobial stewardship programs, which avoid healthcare-related complications and their associated costs.

    IDSA Submits Comments in Response to Medicare's Shared Savings Program Proposed Rule (PDF)

    In a comment letter, IDSA urged Medicare to propose a more flexible approach to the Shared Savings Program that encourages the formation of innovative ACOs and demonstrates the Agency's commitment to work with stakeholders to achieve meaningful reform.

    CDC's Vital Signs on Carbapenem-resistant Enterobacteriaceae (CRE)

    CDC reports on untreatable and hard-to-treat infections from CRE bacteria, which are on the rise.  CRE bacteria have become resistant to all or nearly all of the antibiotics we have today.

    American Medical Association (AMA) Supports IDSA's Antimicrobial Stewardship Proposal (PDF)

    The AMA House of Delegates voted to adopt an IDSA resolution in support of antimicrobial stewardship programs.

    IDSA's World Health Day 2011 Congressional Briefing

    Includes slides on antimicrobial stewardship and resistance.

    Excess Costs and Utilization Associated with Methicillin Resistance for Patients with Staphylococcus aureus Infection (PDF)

    Filice et al., Infection Control and Hospital Epidemiology vol. 31 no. 4 April 2010 365-373.

    This study found that the cost of treating patients with methicillin-resistant Staphylococcus aureus (MRSA) was significantly higher than treating patients with methicillin-susceptible Staphylococcus Aureus (MSSA).  The median cost for 6-months of treatment of an MRSA infection was $34,657 compared to $15,923 for treatment of an MSSA infection.  The higher costs were the result of longer hospital stays, more laboratory and imaging tests, more rehabilitation services, and greater mental, social and spiritual costs.


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