Updated: November 2022
While many microbes are important to our good health, some can cause disease and make us very ill. When this happens, an antimicrobial may be prescribed to help fight the disease. Many of us are most familiar with antibiotics, a kind of antimicrobial, intended to combat harmful bacteria inside the body.
“Antibiotics are a limited resource, meaning bacteria can become more resistant if antibiotics are not used appropriately,” says Dr. Pavani Das, Antimicrobial Stewardship Physician Lead.
Since 2009, North York General Hospital (NYGH) has been auditing its use of antimicrobials. As a patient safety quality initiative, it created its own Antimicrobial Stewardship Program (ASP) in 2011. The program coordinates efforts to:
- Impact adverse patient events
- Combat the emergence of antibiotic resistant organisms
- Improve and measure the appropriate use of antimicrobials
Supporting improved patient outcomes and safety
A successful antimicrobial stewardship program curbs the development of resistant pathogens by encouraging responsible antibiotic use as well as a routine review of guidelines with prescribers. This leads to promoting proper antimicrobial therapy for all patients. “Good stewardship of antibiotics should help health practitioners use the right antibiotic, at the right time, in the right dose, for the right duration,” says Dr. Das.
NYGH's Antimicrobial Stewardship Program develops and implements a variety of strategies to counter the development and multiplication of microbes in the hospital's inpatients.
“Our most successful strategy has been the use of audit and feedback, a mechanism by which we discuss antibiotic decision-making with prescribers (regulated health professionals) in real-time, and provide them with important feedback to optimize their choices as the patient's therapy is in progress,” says Sumit Raybardhan, Infectious Disease Pharmacy Practitioner.
Antimicrobial Stewardship Pharmacist Tiffany Kan explains that they review antibiotic use within the hospital, and collaborate within an interdisciplinary environment to provide feedback to clinicians in order to optimize antimicrobial prescribing and improve patient outcomes and safety. They make recommendations on an individual patient level, but also consider the broader impact of these antimicrobial decisions in the hospital's environment.
“Education of our hospital staff, physicians and learners is also a critical aspect of our program. Our aim is to create a culture of antimicrobial stewardship among our clinicians and future health care professionals so that everyone recognizes the role and responsibility they have to preserve our antibiotic resources,” says Tiffany.
As an ASP physician, Dr. Das makes herself available as a reliable resource for optimal antibiotic utilization and guidance to her physician colleagues. “I also strive to support the day-to-day functions of our pharmacists as well as our ASP team to ensure we are providing a comprehensive approach to our antibiotic recommendations that arise from both clinical considerations and current evidence.”
Creating a Culture of Antimicrobial Stewardship
NYGH's ASP is now over ten years old and thanks to its work has deepened a culture of antimicrobial stewardship throughout the organization.
This has included:
- Developing a strategy to standardize the process used in NYGH to document patient drug allergies including those to antimicrobials to ensure best practices are followed and use of antimicrobials is optimized
- Developing an allergy assessment to be done at the patient’s bedside to ensure appropriate use
- Expanding auditing and feedback services that involve reviewing antibiotic use and guiding clinicians on ways to optimize the prescribing of antimicrobials to the hospital’s oncology, general surgery, cardiology and medicine services.
- Continued participation in research trials aimed at optimizing antibiotic use at NYGH.
During the COVID-19 pandemic, the ASP also expanded its auditing and feedback services in patient units experiencing a surge in COVID cases to inform decisions around using antibiotics as part of treatment. The Program also helped inform the work of the Ontario Science Table as a member of the clinical guidelines working group and led efforts to review patient eligibility for emerging therapeutics and to manage the logistics behind making those therapeutics available to patients, among other tasks.
Left: The Antimicrobial Stewardship Program team from left: Sumit Raybardhan, ASP co-lead and Infectious Disease Pharmacy Practitioner, Linda Li, Antimicrobial Stewardship Pharmacist, Dr. Pavani Das, Antimicrobial Stewardship Physician Lead, and Tiffany Kan, Antimicrobial Stewardship Pharmacist
A common perception may be that antibiotics are useful and harmless in common health care scenarios, such as using them for the common cold (antibiotics only combat bacteria not viruses).
However, antimicrobial resistance is increasing due to overuse and misuse. Additionally, new antimicrobial drug development is slowing. “We need to approach antibiotic use in the same way we approach the use of water — this resource is precious, misuse or overuse is detrimental to people and the environment,” says Dr. Das. “Our responsibility to future generations is to use antimicrobials with caution and careful consideration for the inevitable risks.” As COVID-19 continues to circulate in the community while we head into a winter where cases of other respiratory viruses are on the rise, the need to use antibiotics responsibly remains ever more important.