Department of Medical Microbiology, Crosshouse Hospital, NHS Ayrshire and Arran, UK.
Curr Opin Infect Dis. 2011 Aug;24(4):357-62. doi: 10.1097/QCO.0b013e3283483262.
Antimicrobial stewardship is now recognized as a formal strategy for curbing the upward trend in antibiotic resistance. Literature on antimicrobial stewardship has focused on areas of strategic importance and operational delivery. A number of barriers have been recognized in the implementation of successful programs. These include lack of physician participation, lack of diagnostic facility, absence of formal mechanism of data collection, variation between countries, and lack of cooperative strategies. In this review, we suggest strategies to overcome these barriers.
In the last few years, it has been recognized that an executive program is necessary for successful implementation of strategies to control the growing antibiotic resistance. Efforts have been made at higher levels of government through organizations such as the European Centre for Disease Prevention and Control. The need for community healthcare involvement has also been recognized. At a local level, strategies to promote cooperation between various committees (e.g. infection control and antimicrobial management teams) have been proposed and adopting antibiotic care bundles as part of patient safety and healthcare is being explored.
We suggest that executive level planning, local cooperation, sustained education, emphasis on de-escalation, and use of care bundles could stem the tide of growing resistance.
抗菌药物管理现已被视为遏制抗生素耐药性上升的一种正式策略。有关抗菌药物管理的文献主要集中在具有战略重要性和操作性的交付领域。在成功实施计划方面，已经认识到存在许多障碍。这些障碍包括医生参与度低、缺乏诊断设施、缺乏正式的数据收集机制、国家之间的差异以及缺乏合作策略。在这篇综述中，我们提出了克服这些障碍的策略。
在过去的几年中，人们已经认识到，需要执行一个专门的项目，才能成功实施控制日益增长的抗生素耐药性的策略。通过欧洲疾病预防控制中心等组织，在政府更高层级已经做出了努力。人们还认识到需要社区医疗保健的参与。在地方层面，已经提出了促进各个委员会（例如感染控制和抗菌药物管理团队）之间合作的策略，并正在探索将抗生素护理包作为患者安全和医疗保健的一部分。
我们建议通过执行层面的规划、地方合作、持续教育、强调降级以及使用护理包，可以遏制耐药性不断上升的趋势。
