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A checklist to kick out drug-resistant microbes

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A representative image of Hospital | Research Matters

Researchers propose a set of recommended actions for hospitals to arm them against superbugs.

Antimicrobial resistance, or the resistance developed by pathogens against many drugs, is an emerging global challenge. Imagine being infected by a bug that is not killed by any available drugs! Well, it is now a reality with tuberculosis and pneumonia as some strains of the causative bacteria are becoming resistant to a wide range of antibiotics, thanks to our reckless use of antibiotics. 

Incidentally, hospitals, which are supposed to heal such patients, are instead turning safe havens for these superbugs. Hence, many hospitals across the globe have adopted a set of strategies, under the antimicrobial stewardship (AMS) programme, to fight these superbugs. The programme promotes the appropriate use of antimicrobial agents, ensures a better clinical outcome, and helps to reduce microbial resistance. In a recent international collaborative study, researchers have proposed some ‘core elements’ and checklist items to strengthen this programme. The study was published in the journal Clinical Microbiology and Infection.

The ‘core elements’ of the AMS programme is a document that complements the existing guidelines on fighting antimicrobial resistance from different organisations. These core elements help hospitals to implement the programme effectively. However, the core elements are not well-defined in many countries, and there is a need to define them based on effectiveness and affordability. “Efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for antimicrobial stewardship programmes that should be present in all hospitals worldwide, regardless of resource availability”, say the authors, talking about the motivation behind this study.

After extensive literature survey and evaluations, the researchers of this study came up with a list of seven core elements that are globally relevant. These core elements are centred around how senior hospital management supports the antimicrobial stewardship programme, the accountability and responsibilities of the hospital team towards the program, availability of experts on infection management, education and practical training for antimicrobial prescribing and stewardship, other actions aiming at responsible antimicrobial use, monitoring and surveillance of antimicrobial use, and reporting and feedback on antimicrobial use on a continuous basis.

The researchers also suggest 29 checklist items related to the core elements. These are a set of questions to cross-check the availability or functioning of the core elements. The Centers for Disease Control and Prevention (CDC) had prepared a similar list before, and the authors found that their core elements are very similar to the ones suggested by CDC. The authors claim that hospitals can adopt the proposed core elements and checklist items based on their clinical setting and resource availability.

“We developed minimum core elements and checklist items that could be relevant to hospital antimicrobial stewardship programmes worldwide. Even though most of these checklist items may not currently exist in most hospitals in low-income countries, we included all of them on the list because our main objective was to identify universally relevant, essential elements and items based on the best available evidence”, say the authors.

The suggested approach provides the necessary guidelines to manage the antimicrobial stewardship program to address the global emergence of drug-resistant microbes. “The next step should be to evaluate its value and then its feasibility and measurability in a range of geographic and resource settings, with a broader stakeholder group”, conclude the authors.