Antibiotic Stewardship

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Introduction
1. Background:
Antimicrobial resistance is a global concern for effective health care delivery.(1) Extensive use of antibiotics in healthcare institutes is one of the main causes for emergence of antimicrobial resistance. (2) The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. Unnecessary exposure to antibiotics affects patients’ health seriously; suffering from serious adverse events with no clinical benefit, prolongation of hospital stay, prolonged treatment with antimicrobials or even the need for further surgical intervention; which causes a considerable burden on patients, health care system and the
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Antibiotic stewardship program (ASP):
ASP are hospital based programs dedicated to improving antibiotic use. (14) It aims to the optimization of antimicrobial use to achieve the best clinical outcomes together with minimizing adverse events and limiting selection of resistant bacterial strains. It also can reduce excessive costs due to suboptimal antimicrobial use. Therefore, antimicrobial stewardship is becoming a responsibility for all healthcare institutions.(15)
ASP helps clinicians improve the quality of patient care through decreasing irrational use of antibiotics,(16) increasing infection cure rates thus improving patient’s safety and reducing treatment failures. It also may result in increasing frequency of correct therapeutic and prophylactic prescribing of antimicrobials.(17, 18) Moreover they significantly reduce antibiotic resistance.(19, 20) These goals are often achieved while saving hospitals resources.(14) In 2014, recognizing the urgent need for wise antibiotic use in hospitals and the benefits of ASPs, CDC recommended implementation of ASP in all acute care
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(47) However, antibiotic administration increases the prevalence of antibiotic-resistant bacteria, and predisposes the patient to infection with organisms such as Clostridium difficile, a cause of antibiotic-associated colitis.(15) It is evident that there is excessive and inappropriate use of antibiotics especially in the prevention and treatment of hospital-acquired infections, including SSI prophylaxis.(48) In the latter case, timing of administration of the first dose is a corner stone to success. (49, 50) Yet administeration usually occurs at the wrong time and duration lasts for too long which affects the cost of patient care. It was shown by several studies that the local implementation of practice guidelines can yield significant improvements in antibiotic use and the cost of surgical

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