Improving Antimicrobial Stewardship

The Evolution of Programmatic Strategies and Barriers

Infections caused by antimicrobial resistance in hospitals has increased steadily, causing illness and death and costing the health system.

Guidelines published by the Infectious Diseases Society of America (IDSA) and the Society of Healthcare Epidemiology of America (SHEA) in 2007 outline how an antimicrobial stewardship program (ASP) can be established and maintained. Current guidelines recommend that an infectious disease (ID) physician head an ASP team and be compensated for this service.

In this email survey, physician members of the Emerging Infections Network were asked about their hospital characteristics, whether or not they had an ASP, inappropriate antimicrobial prescribing at their institutions, and barriers to establishing ASPs.

Key Findings:

  • 61 percent had an institutional ASP; 12 percent had plans to start one.
  • 98 percent of ID physicians were involved in their ASP; more than half were highly involved.
  • 52 percent of ID physicians reported no direct compensation for their involvement in the ASP.
  • 67 percent of current programs used post-prescription review with feedback as the primary strategy of the program.
  • Formulary restriction was most used (88%) in programs established longer than 10 years.

Lack of funding or personnel was identified as the primary barrier to establishing effective ASPs.