Bacterial Resistance and Nosocomial Infections Network

Summary
This paper explores five different approaches to antibiotic stewardship, providing examples of how international collaborations can address optimal prescribing. Each approach examined originates from a different country and makes use of a variety of community-based social marketing tools. In the USA, antibiotic stewardship is a programmatic activity that relies on a multidisciplinary approach led by a team of infectious disease clinicians, pharmacists, microbiologists, hospital epidemiologists, and infection preventionists. To support efforts to reduce antibiotic resistance, participants have created treatment guidelines for specific infections and developed online stewardship kits that offer open-ended courses on various topics. Certification programs and onsite mentoring to help hospitals enhance existing programs are also available. South Africa’s antibiotic resistance strategy spans public and private, human, and animal sectors – providing leadership, advocacy for, and strengthening of antibiotic resistance interventions. National training centers provide one-week-long train the trainer mentoring programs in resource limited areas and prescriber, pharmacist, and manager teams countrywide receive practical sessions with follow-up outreach mentorship and onsite support. A cornerstone of Colombia’s antibiotic resistance work is surveillance, with a study group tracking resistance through data submitted by over 30 hospitals. Resulting data reports allow hospitals to see their performance overtime and provide suggestions for antibiotic treatment. Data comparison between hospitals has also been shown to encourage competitiveness, fueling further improvements. In recent years, stewardship in Australia has evolved from programs led by hospital-based infectious disease physicians and clinical microbiologists to encompass the full breadth of the health-care system. Coordination amongst facilities has led to the establishment of voluntary hospital-based surveillance programs and standardized national treatment guidelines. Additionally, the involvement of government agencies has resulted in the production of a state of the nation report, which provides an overview of antibiotic use in primary care settings, veterinary medicine, and food production industries. In the UK, the issues of increased antibiotic resistance and overprescribing antibiotics were initially addressed by a three-year Department of Health initiative allowing hospitals to update anti-infective guidelines, initiate joint ward rounds, implement surveillance and audits, and increase education. Programs have since expanded and range from the introduction of national and local prescribing metrics with feedback, to the creation of national antibiotic toolkits that provide guidance around antibiotic practice, systems, and processes. Campaigns like the Antibiotic Guardian program and infographics depicting superheroes striking back against antibiotic resistance are used to raise awareness and engagement among healthcare providers and the public. Incentive funding and increased access to routine data are also strategies that have played a role in strengthening stewardship.

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