Antimicrobial stewardship programs and renal units in 2019 and beyond
Approximately 30% of antimicrobial doses administered in haemodialysis units are considered unnecessary (D’Agata et al., 2018). Therefore, implementing an antimicrobial stewardship program (AMS program) in our renal units could optimise antimicrobial therapy and at the same time improve patient safety and patient quality of care. AMS programs can be seen as a key tool in facilitating the appropriate use of antimicrobials and help address the problem of antimicrobial resistance and other unintended consequences, such as antimicrobial toxicity and adverse drug reactions (Morency-Potvin et al., 2017). Hospital-based AMS programs have shown positive impacts on optimising the care of patients with infection. The pharmacist, the infectious disease doctor, the clinical microbiologist and the clinical microbiology laboratory all play important roles in ensuring the success of the program (Leuthner & Doerm, 2013). We know best patient care is achieved through multidisciplinary team working and antimicrobial stewardship is an area where pharmacist leaders are key to their success but multidisciplinary team members also play an integral role (Ng et al., 2017).
In Australia, AMS program implementation is now required by the National Safety and Quality Health Service (NSQHS) Preventing and Controlling Healthcare-Associated Infection Standard, and supported by the Australian Commission on Safety and Quality in Health Care Antimicrobial Stewardship in Clinical Care Standard (ACSQHC, 2018). At the present time, does your renal unit have an AMS program to assist in decreasing the number of patients with multidrug-resistant organisms (MDROs)?
It has been identified that developing and implementing an AMS program that follows key elements and interventions in the outpatient dialysis setting can reduce patient mortality, adverse events and costs, and lead to an improvement in antimicrobial susceptibility rates (Cunha & D’Agata, 2016). NSQHS standards recommend the program benefit from a multidisciplinary AMS team and ensuring ongoing education and training for prescribers, pharmacists, nurses, midwives and consumers about AMS, antimicrobial resistance and optimal antimicrobial use (2018). Therefore, the considerations of an AMS program are central to patient care in our renal units in 2019 and beyond as well as to aspects of this journal issue.
I hope you enjoy this issue, which has a range of topics, including the effect of contact precautions and isolation on quality of life and mood for haemodialysis patients colonised with MDROs. Another considers the microbiological characteristics of peritoneal dialysis-related peritonitis in a hospital in Singapore. The third article focuses on research from some Australian renal units which consider the importance of facilitating a multidimensional concept of health literacy to assist patients as they follow their treatment recommendations. The NEN article focuses on supporting an end-stage renal disease patient through her pregnancy to the birth of her child.
The University of Adelaide, SA, Australia
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2018). Antimicrobial Stewardship in Australian Health Care 2018. Sydney: ACSQHC.
Cunha, C. B., & D’Agata, E. M. (2016). Implementing an antimicrobial stewardship program in out-patient dialysis units. Current Opinion in Nephrology and Hypertension, 25(6), 551–555.
D’Agata, E., Tran, D., Bautista, J., Shemin, D., & Grima, D. (2018). Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities, Clinical Journal of the American Society of Nephrology, 13(9), 1389–1397; DOI: https://doi.org/10.2215/CJN.12521117
Leuthner, K., & Doerm, G. (2013). Antimicrobial stewardship programs. Journal of Clinical Microbiology. 51(2), 3916–3920.
Morency-Potvin, P., Schwartz, D. N., & Weinstein, R. A. (2017). Antimicrobial stewardship: how the microbiology laboratory can right the ship. Clinical Microbiological Reviews, 30, 381–407. https://doi.org/10.1128/CMR.00066-16
Ng, T., Phang, V., Young, B., Tan, S., Tay H., Tan, M., Ling, L., Ang, B., Teng, C., & Lye, D. (2017). Clinical impact of non-antibiotic recommendations by a multi-disciplinary antimicrobial stewardship team, International Journal of Antimicrobial Agents, 50(2), 166–170.