What is Antimicrobial Stewardship and Why is it Important?

Veterinarian
FAASTsheet 02 /

Preserving the Efficacy of Antimicrobials

Across the globe, scientists are recognizing an increase in the incidence and prevalence of bacterial infections resistant to antimicrobials1. There has been increased focus on implementation of prudent antimicrobial use guidelines to slow the spread of resistance in human and animal populations. These guidelines aim to reduce exposure of bacteria to these drugs to lessen the selection pressure that accelerates the emergence of antimicrobial resistance (AMR)2.

A recent systematic review suggests that a reduction in the use of antimicrobial agents can indeed result in a reduction in the prevalence of AMR bacteria in both animal and human populations (especially in humans having direct contact with animals)4.

The Government of Canada has developed a strategy, entitled “Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Framework for Action”, using a One Health approach designed to address AMR across the country1. The framework has four key pillars:

  1. Surveillance – to provide a comprehensive picture of AMR and AMU in Canada
  2. Infection Prevention and Control – to contain the spread of AMR and reduce the need for AMU
  3. Antimicrobial Stewardship – programs focusing on education, awareness and regulatory oversight to reduce inappropriate prescribing and dispensing of antimicrobials in humans and animals, and to promote other means of maintaining health and preventing infections
  4. Research and Innovation – to better understand the development of AMR and find novel, efficacious antimicrobials and antimicrobial alternatives to fight and prevent infections

Antimicrobial Stewardship and Veterinarians

Veterinarians are experts in animal health. By virtue of their advanced training in science and medicine, their professional accountability, and their duty to promote and protect animal, public, and environmental health, veterinarians are uniquely qualified to lead in the provision of guidance on antimicrobial stewardship.

Researchers have defined the “5 R” approach for antimicrobial stewardship3:

  • Responsibility

    Everyone who uses antimicrobials is responsible for using them appropriately. This is especially so for veterinarians, who use, prescribe, and dispense antimicrobials on a regular basis, and are thus central agents in ensuring good stewardship in animals.

  • Reduction

    Removing the selective pressure of antimicrobials in an effort to slow or reverse the development of AMR. This should include preventative practices to reduce infectious disease, such as vaccination and enhanced biosecurity.

  • Refinement

    Target drug and dosing regimen to the signalment of the patient, likely pathogen, and the properties of the antimicrobial agent to maximize the odds of treatment success.

  • Replacement

    Whenever possible, seek out efficacious alternatives to antimicrobial agents

  • Review

    Periodic assessment of AMU practices should be performed to ensure compliance with regulatory initiatives and alignment with current scientific evidence

New regulations call on veterinarians to adopt a leadership role in antimicrobial stewardship to tackle the threat of AMR.

Important Definitions

Antimicrobials – those natural or synthetic compounds that kill microorganisms (i.e. bacteria, fungi, parasites, viruses) or slow their growth.

Antibiotics – Antimicrobials that have activity against bacteria

Antimicrobial Stewardship – the multifaceted approaches required to sustain the efficacy of antimicrobials and minimize the emergence of AMR.4

Antimicrobial Use (AMU) – the employment of antimicrobial agents to kill or slow the growth of microorganisms

Antimicrobial Resistance (AMR) – the multifactorial process by which microorganisms (bacteria, fungi, parasites, viruses) naturally have, develop or acquire elements that enable them to survive in the presence of those antimicrobials (antibiotics, antifungals, anthelmintics, antivirals) designed to kill them or slow their growth.

One Health Approach – This approach to public health problems recognizes that the health of humans, animals, and the environment are deeply interconnected. Any health problem spanning the human-animal-environment interface necessitates a coordinated, collaborative, multidisciplinary, and cross-sectoral approach to realize an effective solution.

For More Information

Videos

AMR in North America

Canada’s Response to the AMR Crisis

Next FAASTsheet

Categorization of Antimicrobial Drugs Based on Importance in Human Medicine

References

  1. Public Health Agency of Canada. Tackling Antimicrobial Resistance and Antimicrobial Use A Pan-Canadian Framework.; 2017
    https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/tackling-antimicrobial-resistance-use-pan-canadian-framework-action.html
  2. Holmes AH, Moore LSP, Sundsfjord A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176-187. doi:10.1016/ S0140-6736(15)00473-0.
  3. Page S, Prescott J, Weese S. Antimicrobial resistance: The 5Rs approach to antimicrobial stewardship. Vet Rec. 2014;175(8):207-208. doi:10.1136/vr.g5327.
  4. Giguere S, Prescott, JF, and Dowling, PM. Antimicrobial therapy in veterinary medicine. 2013. Fifth edition, Wiley Blackwell. Ames, Iowa, U.S.A. pp. 118.