Hospital antibiotic stewardship.
OBJECTIVE
Antibiotic stewardship is designed to optimize antimicrobial therapy administered to hospitalized patients, to ensure cost-effective therapy and improve patients' outcome while containing bacterial resistance. Current data on the development of effective programmes, including guidelines for their implementation, have demonstrated some efficacy and controversies are reviewed.


RESULTS
Guidelines have been recently issued for the development and implementation of active antibiotic stewardship programmes in hospitals. A multidisciplinary team including at least an infectious disease physician and a clinical pharmacist is required. Multiple strategies are available, including prospective audit with feedback to the provider, education and antimicrobial restriction. Interventions have shown a positive effect on optimization of antimicrobial use, reduced costs and bacterial resistance, but studies showing improvement in patient outcomes are sparse. Results of studies may be confounded by several factors, mainly due to their before-after design and lack of control for cointerventions.


CONCLUSIONS
Combined with an effective infection control programme, antibiotic stewardship can help contain antimicrobial resistance. Studies demonstrating improvement of patients' outcomes are needed to increase acceptance by a broader audience of physicians. A proactive strategy of prospective auditing with direct counsels and feedback to the prescriber, ensuring systematic reassessment of ongoing therapy, appears most useful.
Lesprit
Philippe
P
Infection Control Unit, Université Paris 12, Assistance Publique-Hôpitaux de Paris, Hopital Henri Mondor, Créteil, France.
Brun-Buisson
Christian
C
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016134:Organizational Policy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents