A whole-health–economy approach to antimicrobial stewardship: Analysis of current models and future direction

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 Mar 2019)

Policy Forum
A whole-health–economy approach to antimicrobial stewardship: Analysis of current models and future direction
Monsey McLeod, Raheelah Ahmad, Nada Atef Shebl, Christianne Micallef, Fiona Sim, Alison Holmes
| published 29 Mar 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002774
Summary points
:: Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown.
:: Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap.
:: Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening.
:: Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach.
:: More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts.
:: Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach.