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Antimicrobial Stewardship

19/Mar/2013; 신규 교원 교육.

Jin-Hong Yoo

on 8 January 2017

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Transcript of Antimicrobial Stewardship

Antimicrobial Stewardship Hospital administrator Jin-Hong Yoo, MD PhD Dept. of Internal Medicine,
The Catholic University of Korea,
College of Medicine Steward Ste: household
ward: warden or keeper An official who is appointed by the legal ruling monarch to represent him or her in a country
He or she may have a mandate to govern it in his or her name.
청지기; 집사. Stewardship The responsibility of looking after property.
An ethic that embodies responsible planning and management of resources. The 3 components of stewardship Antimicrobial
Stewardship A program or interventions to monitor & direct antimicrobial use at a health care institution, thus providing a standard, evidence-based approach to judicious antimicrobial use. Goals of stewardship To provide the best patient outcomes To lessen the risk of adverse events To promote cost-effectiveness To reduce (or stabilize) levels of resistance Day-to-day activities of a stewardship program Clinical Pharmacist Need to be supported by an infectious-diseases physician Education
Pre- & postprescription review
Guideline Infection control practitioner Combination of antimicrobial stewardship with a comprehensive infection control program. Microbiology Laboratory Provide data
: Local data of antimicrobial susceptibility profiles Feedback to aid streamlining of stewardship Committee Selecting
Regular meeting IT(Information Technology) Providing electronic sources of antimicrobial usage and microbiological data to perform the stewardship program Supporting the measurement of effect of the program. CDSS 추진력/강제력 집행력 Infectious Disease Physician Guidance
Cooperation with ICP
Central role in the interdisciplinary approach Strategies of Stewardship Education/guidelines
Review & Feedback
Computer assistance (CDSS) 3-tier classification system Unrestricted Controlled Restricted Could be dispensed for a few days(24~48h?) without approval
If prolonged, authorization is needed. Which microbials? Significant resistance / last card 여부를 기준
3rd & 4th generation antibiotics
New fluoroquinolones
Other new antimicrobials (eg. Ketolides, synercid, etc.)
Antifungals : caspofungin, voriconazole, etc. Daily review of targeted antimicrobials for appropriateness.
Contact prescribers with recommendations for alternative therapy. Streamlining
Modification of initial empiric regimen
Discontinuation of empiric therapy when cause of illness does not require antimicrobial therapy
Dose optimization
Parenteral to oral antimicrobial conversion
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