Defining an antimicrobial monitoring service

The widespread use of antimicrobial agents is one of the most important public health issues.1 Antimicrobial stewardship programs have gained the attention of clinicians and health care administrators.2 Antimicrobials account for up to 30% of hospital drug budgets, and over 50% of hospitalized patients are treated with antibiotics.3,4 Up to 50% of antimicrobial use is inappropriate, contributing to less than optimal patient care and increased health care costs.2,–4 In addition, inappropriate antimicrobial therapy is associated with increased mortality, adverse drug reactions, and emergence of multidrug-resistant bacteria.5 The Interagency Task Force on Antimicrobial Resistance (cochaired by the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health) assembled a global document that addressed the threat of increasing resistance and stressed the importance of judicious antimicrobial use.2 Studies indicate that oversight of antimicrobial use results in a measurable impact on antimicrobial expenditures. A variety of approaches to antimicrobial stewardship have been reported, but the optimal structure has not been established.6,–9 Surveys have shown that antimicrobial oversight in inpatient settings is not routinely implemented, and when it is implemented, it is frequently inadequate.10,–13