ANTIMICROBIAL STEWARDSHIP
CORE COMPETENCIES OF ANTIMICROBIAL STEWARDSHIP
continued from page 2
While all disease cannot be prevented,
a substantial proportion of infectious
diseases are preventable through practical
means (e.g. controlling underlying risk
factors, vaccination, reducing stress, good
management, aseptic technique).
Confidence
While not a specific strategy,
antimicrobials are often used ‘just in
case’ whether it is because a clinician
worries about missing a bacterial
infection or is wary of convincing owners
that antimicrobials are not necessary.
This approach neglects to consider the
potential costs of unnecessary treatment
(e.g. cost, adverse effects, resistance).
Often, people perceive that a negative
consequence of not doing something (e.g.
a complication developing in a patient
they chose not to treat) is ‘their fault’,
while a complication that occurs during
unnecessary treatment is the fault of the
drug, the manufacturer or an unavoidable
biological risk.
Defensive medicine can drive abundant
unnecessary antimicrobial use.
Confidence with treatment decisions and
clear client communications are often
the biggest contributors to a solid step
forward to better stewardship.
IMPLEMENTATION OF AN ANTIMICROBIAL STEWARDSHIP
PROGRAM IN YOUR PRACTICE
Any practice can implement some
components of an effective ASP
with little effort, time, cost or
access to other personnel.
The approach to an ASP will vary greatly
between facilities, based on a range
of factors such as the nature of the
caseload, the type of animals (food
vs companion vs performance) the
prevalence of resistant pathogens,
the current state of antimicrobial use,
access to specialists, client knowledge
and perceptions, clinician motivation,
management motivation and level of
understanding of the issues.
Any practice can implement some
components of an effective ASP with
little effort, time, cost or access to other
personnel.
Often, starting with some easy measures
(low hanging fruit) is useful to facilitate
acceptance of change, with addition
of new measures over time as people
realize the potential benefits. An ASP is
meant to help, not hamper, patient care.
TABLE 1:
POTENTIAL COMPONENTS OF A VETERINARY ANTIMICROBIAL
STEWARDSHIP PROGRAM
Antibiogram data collection and use Automatic stop orders
Cascading microbiology susceptibility
reporting Checklists (e.g. surgical)
Computerized decision support systems De-escalation and streaming
Disease-specific treatment guidelines Surgical prophylaxis guidelines
Dose optimization Formulary restriction
Formulary restriction with pre-
authorization Formulary restriction with authorization
Computer-based identification
of inappropriate pathogen/drug
combinations Improved antimicrobial documentation
Improved diagnostics IV to oral conversion
Prescriber education User (owner) education
Prevention of treatment of non-infectious
conditions Promotion of timely and appropriate
microbiological sampling
Prospective audit with feedback (clinician/ Scheduled antimicrobial re-assessments
service/facility)
(antibiotic time-outs)
Strategic microbiology results reporting Targeted review for redundant therapy/
therapeutic duplication
Therapeutic drug monitoring Infection prevention and control
Instilling public confidence in veterinary regulation
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