Multidisciplinary antimicrobial management teams: the way forward to control antimicrobial resistance in hospitals

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Microbial resistance to anti-infective drugs is recognized as a major public health threat [1,2]. In hospitals, it has become a daily concern for the infectious diseases specialist, microbiologist, pharmacist and infection control team. Several factors are driving the increasing prevalence of antibiotic-resistant bacteria in hospitals, including the selection of resistant mutants by antibiotic exposure, the transfer of genetic determinants of resistance between bacterial strains, and the clonal spread of resistant strains among hospitalized patients within and between institutions. These mechanisms are fuelled by excessive antibiotic use and poor compliance with infection control standards. After outbreaks of nosocomial infections caused by antibiotic-resistant strains, some of which are resistant to all currently available drugs, these strains become endemic in many regions [1,2]. Infections caused by resistant bacteria such as methicillin-resistant Staphylococcus aureus or multiresistant Pseudomonas aeruginosa and Acinetobacter baumannii have been associated with increased morbidity, mortality and healthcare costs [3,4].As many as half of the patients in acute care hospitals receive antibiotics for therapy or prophylaxis. Many studies have shown that hospital physicians often prescribe antibiotics both excessively and inappropriately [2]. Beyond the complexity of diagnosing and managing infectious diseases, a number of factors contribute to this problem: insufficient medical education regarding microbiology and infection; limited access to or underuse of microbiological testing by clinicians; insufficient information on the local epidemiology of resistance; pressure to reduce the duration of hospital stay and the fear of litigation leading to the defensive use of broad-spectrum drugs; and the promotional activities of pharmaceutical companies. The increased usage of broad-spectrum and newer drugs puts pressure on the selection of resistance in the hospital flora as well as on the hospital budget.A number of scientific societies and public health authorities have published guidelines for curtailing antibiotic resistance in hospitals [2-6]. These advocate a combination of the prudent use of antibiotics and good infection control practices. Key components of antibiotic control programmes are: coordination between hospital administrators, clinicians, infectious diseases specialists, the infection control team, microbiologists and hospital pharmacists; formulary-based local guidelines on anti-infective drug indications, dosage and duration; education and regulation of prescription by consultant specialists; monitoring the quantity and auditing the quality of drug use; microbiological monitoring and dissemination to clinicians of information on local bacterial resistance patterns; detection and reporting of patients colonized with communicable resistant bacteria to clinicians and the infection control team; and the promotion of hospital infection control practices such as hand hygiene [2-6].In this editorial, I want to emphasize the importance of multidisciplinary antibiotic management teams. Because the problem of increasing antibiotic resistance is so multifaceted, a well coordinated, multimodal control programme is needed. Local consensus building is the crucial first step in developing a local policy. Implementation of this policy into clinical practice requires the cooperation of specialists involved in infection control, infectious diseases management, the regulation of antibiotic use, staff education, and assessment of the quality of care in these fields. The recommendation was made at the European Union Conference ‘The Microbial Threat’, held in Copenhagen in 1998, that every hospital should establish an antibiotic team that includes clinical microbiologists, infectious disease specialists, and other relevant clinical specialties. This statement echoed the longstanding recommendation made by the Infectious Disease Society of America [7].What should be the tasks and responsibilities of the different partners of the antibiotic team? Clinical microbiologists play a pivotal role. First, they ensure that the laboratory provides timely identification of microbial pathogens and selective reporting of antibiotic susceptibility profiles [8].

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