Antimicrobial Stewardship

Antimicrobial Stewardship

1st Edition - April 1, 2017

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  • Editors: Céline Pulcini, Onder Ergonul, Füsun Can, Bojana Beović
  • eBook ISBN: 9780128134610
  • Paperback ISBN: 9780128104774

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Antimicrobial Stewardship (AMS), Volume Two includes the experience of ESGAP workshops and courses on antibiotic stewardship since 2012. It combines clinical and laboratory information about AMS, with a focus on human medicine. The ESCMID study group on antibiotic policies (ESGAP) is one of the most productive groups in the field, organizing courses and workshops. This book is an ideal tool for the participants of these workshops. With short chapters (around 1500 words) written on different topics, the authors insisted on the following points: A ‘hands on’, practical approach,  tips to increase success, a description of the most common mistakes, a global picture (out- and inpatient settings, all countries) and a short list of 10-20 landmark references.

Key Features

  • Focuses on the most recent antimicrobial stewardship strategies
  • Provides a detailed description of laboratory support
  • Offers a balanced synthesis of basic and clinical sciences for each individual case, presenting clinical courses of the cases in parallel with the pathogenesis and detailed microbiological information for each infection
  • Describes the prevalence and incidence of the global issues and current therapeutic approaches
  • Presents the measures for infection control


Academics and researchers in microbiology, immunology, infectious diseases, medical students, clinicians, laboratory scientists, infection preventionists and public health

Table of Contents

  • Section A: The Global Picture of Antimicrobial Use and Resistance

    Chapter 1: The Global Crisis of Antimicrobial Resistance

    • Abstract
    • Introduction
    • Mechanisms of AMR
    • AMR in Gram-Positives
    • AMR in Gram-Negatives

    Chapter 2: Antimicrobial Stewardship: Efficacy and Implementation of Strategies to Address Antimicrobial Overuse and Resistance

    • Abstract
    • Key Points
    • Introduction
    • The Relationship Between Antibiotic Use and Drug Resistance
    • The Evidence Supporting Antimicrobial Stewardship Strategies
    • Choosing a Stewardship Strategy
    • Implementation of an ASP in Nontertiary Care Settings
    • Building the Stewardship Team
    • Messaging the Importance of Antimicrobial Stewardship
    • Summary

    Chapter 3: Quality Indicators and Quantity Metrics of Antibiotic Use

    • Abstract
    • Quality Versus Performance Indicators
    • Measuring Performance
    • Quantity Metrics and Quality Indicators of Antibiotic Use: What is the Difference?
    • Quantity Metrics
    • Outpatient and Inpatient Antibiotic Use: How to Measure?
    • Quality Indicators
    • Outpatient Quality Indicators
    • Inpatient QIs
    • Conclusion

    Section B: AMS Strategies

    Chapter 4: Improving Antimicrobial Prescribing: Input from Behavioral Strategies and Quality Improvement Methods

    • Abstract
    • Stewardship Interventions
    • Effectiveness of Behavioral Stewardship Interventions
    • The Importance of Understanding the Key Drivers of Current Prescribing Behavior
    • The Key Drivers of Current Antimicrobial Prescribing Behavior
    • Use of Theories in Selecting and Developing Behavioral Stewardship Interventions
    • Use of Systematic Reviews of Behavioral Interventions in Selecting and Developing Behavioral Stewardship Interventions
    • Conclusion

    Chapter 5: Education of Healthcare Professionals on Responsible Antimicrobial Prescribing

    • Abstract
    • Introduction
    • Undergraduate Education of Prescribers
    • What Content Should Be Included for Undergraduates?
    • How Should Content Be Structured and Delivered in an Undergraduate Program?
    • Postgraduate Education of Prescribers
    • Medical Doctors in Training (Internship, Specialization)
    • Continuing Medical Education and Continuing Professional Development
    • Types of Educational Activities for Healthcare Professionals
    • Education of Other Healthcare Professionals in Antimicrobial Stewardship
    • Competencies in Antimicrobial Stewardship
    • Key Issues
    • Steps Forward

    Chapter 6: Rapid Diagnostics and Biomarkers for Antimicrobial Stewardship

    • Abstract
    • Introduction
    • Rapid Diagnostic Tests
    • Biomarkers
    • Conclusions

    Chapter 7: Pharmacokinetic and Pharmacodynamic Tools to Increase Efficacy

    • Abstract
    • Introduction
    • PK/PD of Antimicrobials: Efficacy and Resistance
    • Dose Optimisation Strategies
    • Conclusion

    Chapter 8: The Use of Computerized Decision Support Systems to Support Antimicrobial Stewardship Programs

    • Abstract
    • Introduction
    • Passive Decision Support and Mobile Applications
    • Back-End Computerized Decision Support and Surveillance Systems
    • Antimicrobial Restriction/Approval Based Systems
    • Electronic Prescribing Systems (With or Without CDSS)
    • Advanced Decision Support
    • Implementation Barriers
    • Conclusions

    Chapter 9: The Role of Microbiology Laboratory in Promoting Antimicrobial Stewardship

    • Abstract
    • Introduction
    • Rapid Diagnostic Tests (RDTs)
    • Antimicrobial Susceptibility Testing
    • Communication between AMS team members

    Chapter 10: The Role of Pharmacists

    • Abstract
    • Introduction
    • Hospital Pharmacy
    • Antimicrobial Stewardship Programs
    • Therapeutic Drug Monitoring and Dose Optimisation
    • Audit and Feedback
    • Surveillance of Antimicrobial Consumption and Linking to Resistance
    • Procurement, Medicines Preparation and Managing Shortages
    • Risk Management
    • Education of Healthcare, Staff and Patients
    • Primary Care Pharmacy
    • Community Pharmacy

    Chapter 11: The Roles of Nurses in Antimicrobial Stewardship

    • Abstract
    • Introduction
    • Nurses With Prescribing Rights
    • Nonprescribing Staff Nurses in Hospitals, in the Outpatient Setting and in Long Term Care Facilities
    • Nurses Working Within an AMS Team
    • Conclusions and Perspectives

    Chapter 12: Antifungal Stewardship

    • Abstract
    • Introduction
    • Basic Principles of Antifungal Stewardship
    • Invasive Candidiasis
    • Diagnosis (Table 3)
    • Invasive Aspergillosis
    • Diagnosis

    Section C: AMS in Specific Clinical Settings

    Chapter 13: Optimising Prescribing for Acute Respiratory Tract Infections as an Example for Antimicrobial Stewardship in Primary Care

    • Abstract
    • Antibiotics in Primary Care
    • Barriers to Rational Use of Antibiotics
    • Approaches to AMS in Primary Care
    • Governance and the Public
    • Conclusions

    Chapter 14: Antimicrobial Stewardship: What to Tell the Patients and the General Public

    • Abstract
    • Background
    • Studies of Patient Satisfaction
    • Knowledge on Antimicrobials and Resistance
    • Campaigns
    • Measuring the Impact of Interventions
    • Campaign Messages

    Chapter 15: Antimicrobial Stewardship in Long-Term Care Facilities

    • Abstract
    • Introduction
    • Antibiotic Use in LTCFs
    • Bacterial Resistance in LTCFs
    • Antibiotic Prescribing: A Challenge in LTCFs
    • Potential Strategies to Improve Antibiotic Use in LTCFs
    • Conclusions and Perspectives

    Chapter 16: Antimicrobial Stewardship in ICU

    • Abstract
    • Introduction
    • Definition of AMS in the ICU, Rationale for Stewardship. Who Does What?
    • Appropriate Diagnostics in Suspected Bacterial Infections in ICU Patients
    • Selection of Initial Antibiotic Therapy and Timeliness
    • Pharmacokinetic-Pharmacodynamics-Optimized Antimicrobial Therapy
    • Antimicrobial Therapy De-escalation
    • Shortening Antimicrobial Treatment Duration
    • Implementing a Structured Antibiotic stewardship Program
    • Measuring Effectiveness of an AMS in ICU: Quality Indicators and Bundle Approach; Quantity Metrics
    • Decision Support/Use of Modern Technology to Optimize Antibiotic Stewardship Programs in ICU

    Chapter 17: Antimicrobial Stewardship in Hematology Patients

    • Abstract
    • Introduction
    • Epidemiology of Infecting Bacteria and Their Antimicrobial Susceptibility in Patients with Hematological Malignancies
    • Early Diagnostic Strategies
    • Are All Patients With Febrile Neutropenia Equal? Risk Assessment for a Complicated Infection
    • Prevention of Infection and Prophylaxis
    • Optimizing Antibiotic Delivery With Pharmacokinetics/Pharmacodynamics (PK/PD) Considerations in Patients With Febrile Neutropenia
    • Role of Infectious Diseases (ID) Consultation and Cooperation With Microbiology for the Management of Patients With Febrile Neutropenia
    • Empirical Antimicrobial Strategies
    • Targeted Therapy for Documented Infections
    • How Long is Long Enough for Empirical and Targeted Antibacterial Therapy in Patients With Febrile Neutropenia?
    • Conclusions
    • Case Studies-I
    • Case Studies-II

    Chapter 18: AMS in an Era of Multidrug-Resistant Bacteria

    • Abstract
    • 18.1 Infections Due to ESBL-Producing Bacteria: How to Promote AMS?
    • 18.2 An Outbreak of Carbapenem-Resistant or Polymyxin-Resistant Strains: How Can Antimicrobial Stewardship Help?

    Section D: AMS Experiences Around the World

    Chapter 19.1: AMS Initiatives and Policies: The International Picture

    Chapter 19.2: Missions and Objectives of EUCIC and ESGAP

    Chapter 19.3: Antimicrobial Stewardship in Latin America

    Chapter 19.4: Antimicrobial Stewardship in Australia

    Chapter 19.5: Antimicrobial Stewardship in Austria

    Chapter 19.6: Antimicrobial Stewardship in Belgium

    Chapter 19.7: Antimicrobial Stewardship in Bulgaria

    Chapter 19.8: Antimicrobial Stewardship in Croatia

    • Introduction
    • Actions Taken
    • Main Challenges
    • Actions Needed

    Chapter 19.9: Antimicrobial Stewardship in England

    Chapter 19.10: Antimicrobial Stewardship in France

    Chapter 19.11: Antimicrobial Stewardship in Germany

    • Background
    • Key Developments and Programmes Associated With Improvements in Responsible Antibiotic Use
    • Main Challenges
    • What Is Needed?

    Chapter 19.12: Antimicrobial Stewardship in Greece

    • Efforts and Challenges in the Greek Context
    • What Is the Next Step?

    Chapter 19.13: Antimicrobial Stewardship in India

    Chapter 19.14: Antimicrobial Stewardship in Israel

    Chapter 19.15: Antimicrobial Stewardship in Italy

    • The region Emilia Romagna
    • The region Friuli Venezia Giulia
    • The province of Bolzano

    Chapter 19.16: Antimicrobial Stewardship in Japan

    Chapter 19.17: Antibiotic Stewardship in the Netherlands

    Chapter 19.18: Antimicrobial Stewardship in Scotland

    Chapter 19.19: Antimicrobial Stewardship in Slovenia

    Chapter 19.20: Antimicrobial Stewardship in South Africa

    Chapter 19.21: Antimicrobial Stewardship in Argentina

    Chapter 19.22: Antimicrobial Stewardship in Spain

    Chapter 19.23: Antibiotic Stewardship in Sweden

    • Background
    • Formation of Strama: The Swedish Strategic Programme Against Antibiotic Resistance
    • Main Successes of the Strama Work
    • Current Challenges
    • What Is Needed Now?

    Chapter 19.24: Antimicrobial Stewardship in Switzerland

    Chapter 19.25: Antimicrobial Stewardship in Turkey

    Chapter 19.26: Antimicrobial Stewardship in the United States

    Section E: Research and Perspectives

    Chapter 20: Methodological Challenges in Evaluating Antimicrobial Stewardship Programs: “Through Measuring to Knowledge”

    • Abstract
    • Key Points
    • Introduction
    • Study Design
    • Statistical Methods
    • Conclusions

Product details

  • No. of pages: 394
  • Language: English
  • Copyright: © Academic Press 2017
  • Published: April 1, 2017
  • Imprint: Academic Press
  • eBook ISBN: 9780128134610
  • Paperback ISBN: 9780128104774

About the Editors

Céline Pulcini

Céline Pulcini is Full Professor of Infectious Disease in Nancy, France. Her main research interest lies in antimicrobial stewardship and vaccination practices with the aim of preventing the emergence of bacterial resistance to antibiotics. Professor Pulcini is Secretary of ESGAP, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Antibiotic Policies. She is or has recently served also as Expert for the National Antibiotic Plan of the French Ministry of Health, the ECDC and the WHO. She is a member of the Executive Committee of the French Infectious Diseases Society (SPILF) and she coordinates the SPILF Antimicrobial Stewardship working group. In addition to this, Professor Pulcini is a partner in the European Innovative Medicines Initiative project ‘DRIVE-AB’. As well as serving as an Associate Editor for the journal Clinical Microbiology and Infection, Professor Pulcini has also authored or co-authored over 130 international publications. She received in 2017 the ESCMID Young Investigator Award.

Affiliations and Expertise

Professor of Infectious Diseases, University of Lorraine, Nancy University Hospital, Nancy, France

Onder Ergonul

Onder Ergonul
Onder Ergonul, MD, MPH has been a professor of Infectious Diseases and Clinical Microbiology at Koç University, School of Medicine since 2011. He graduated from Hacettepe University School of Medicine in 1989 and completed his residency in 1996 in the Infectious Diseases and Clinical Microbiology department of Ankara University in Ankara, Turkey. He received his Master of Public Health degree from Harvard University School of Public Health in 2003. In 2000-2002, he worked as a research fellow in the Clinical Epidemiology division of the Infectious Diseases Department at the University of Utah, School of Medicine, USA. He is the editor of a book on Crimean-Congo Hemorrhagic Fever (2007, Springer). He received the Public Health Scientific award of Turkish Medical Association in 2007. He has been the president of the Turkish Society of Clinical Microbiology and Infectious Diseases since 2013. He has been the associate editor of Clinical Microbiology and Infection, official journal of the European Society of Clinical Microbiology and Infectious Diseases since 2013. He was elected as the member of Science Academy of Turkey in 2013.

Affiliations and Expertise

Professor of Infectious Diseases and Clinical Microbiology, Koc University School of Medicine, Istanbul, Turkey

Füsun Can

Fusun Can is Professor of Microbiology at KOC University, School of Medicine, Rumeli Feneri Mh, Istanbul in Turkey.

Affiliations and Expertise

Professor of Microbiology, KOC University, School of Medicine, Rumeli Feneri Mh, Istanbul, Turkey

Bojana Beović

Prof. Bojana Beović, MD, PhD graduated at Medical School University in Ljubljana where she obtained her master degree and PhD. She was further educated in pharmacology at the University of Zagreb, Croatia and at The University of Wisconsin Hospital and Clinics. From 2006 to 2009 she was the president of the Health Council at the Ministry of Health of Slovenia. From 2012 to 2017, she was the President of the Educational Council at the Medical Chamber of Slovenia. Currently, she is the head of the ID Consultancy Service at UMC Ljubljana, and vice chair of the Department of Infectious Diseases. Since 2004 she is the president of the Slovenian Society of Chemotherapy and since 2005 the vice-president of the Intersectoral Coordination Mechanism for Prudent Use of Antimicrobials at the Ministry of Health. Since 2008 she is the head of the Antibiotic Committee in UMC Ljubljana. Since 2015 she is the chair of the European Society of Clinical Microbiology and Infectious diseases (ESCMID) Study group for Antibiotic policies (ESGAP). She actively participates in several European level initiatives in the field of antimicrobial resistance and stewardship. She is full professor of infectious diseases at the Medical School, University of Ljubljana. She was the organizer and co-organizer of several international and national scientific meetings and educational courses, and the author of several national antimicrobial guidelines and handbooks on antimicrobial therapy. Her current focus of interest in research is antibiotic stewardship, infections in surgery, and infections with multiple resistant bacteria.

Affiliations and Expertise

Professor, Department of Infectious Diseases, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Slovenia

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