The 2025 ASP (Antimicrobial Stewardship Programm): New Opportunities for Optimizing Antimicrobial Therapy for Multidrug-Resistant Infections and Containment of Antimicrobial Resistance

The complex of measures necessary for hospitals to rationalize the use of antimicrobial drugs, contain antibiotic resistance, and control nosocomial infections is known internationally as "Antimicrobial Stewardship", and in Russia as "Strategy for the Control of Antimicrobial Therapy" (ASP). The ASP program is based on the principle of stratification of patients according to the risk of having multidrug-resistant Gram-negative pathogens in both community-acquired infections (risk of extended-spectrum betalactamases — ESBL) and nosocomial infections. Compared with the previous 2018 document, the current 2025 SKAT guidelines revise patient risk stratification for multidrug-resistant pathogens, taking into account the current realities of the spread of carbapenem-resistant Gram-negative bacteria; they also provide recommendations for the empirical selection of antimicrobial agents in cases of potential risk of multidrug-resistant pathogens with an emphasis on the containment of antimicrobial resistance. Reasonable recommendations are given for the implementation of a carbapenem-sparing strategy for antimicrobial therapy in patients of type II stratification, prioritizing the appointment of beta-lactams with a beta-lactamase inhibitor; in patients of type IIIb stratification at risk of carbapenem-resistant pathogens, combined antibacterial therapy is justified, including therapy regimens that incorporate carbapenem, among which biapenem is characterized by the greatest stability to metallo-carbapenemases. The new section of the SKAT 2025 recommendations focuses on optimizing the dosage of antibiotics, including recommendations on the dosage of antibiotics during renal replacement therapy, extracorporeal membrane oxygenation, as well as for ICU patients with sepsis and increased renal clearance. The new sections also address issues of microbiological monitoring, as well as the implementation of training activities in the hospital. The Russian practical recommendations "The SKAT Program for Inpatient Medical Care" are a tool for developing inpatient programs aimed at optimization of diagnostics and improvement of treatment outcomes for community-acquired and nosocomial infections with an emphasis on curbing antimicrobial resistance.