Abstract
SummaryIt is more than two decades ago that a European Union conference on “The Microbial Threat” hosted by the Danish Government in Copenhagen in September 1998 issued recommendations to encourage good practice in the use of antimicrobial agents and reduce inappropriate prescribing. Essential components of those recommendations were antimicrobial teams in hospitals and the use of feedback to prescribers as well as educational activities. Two decades later, important surveillance systems on both antimicrobial resistance as well as on antibiotic consumption are functioning at the European level and in most European countries; European Committee on Antimicrobial Susceptibility Testing (EUCAST) has thoroughly re-evaluated, standardized and harmonized antibiotic susceptibility testing and breakpoints; there have been educational activities in many countries; and stewardship teams are now included in many guidelines and policy papers and recommendations. Yet, antimicrobial resistance problems in Europe have shifted from methicillin-resistant Staphylococus aureus (MRSA) to vancomycin-resistent Enterococcus faecium (VRE) and to multidrug-resistant gramnegative bacteria, while antibiotic consumption volumes, trends and patterns across countries do not show major and highly significant improvements. The way to go further is to recognize that better prescribing comes at a cost and requires investment in expert personnel, practice guideline drafting, and implementation aids, and, secondly, the setting of clear goals and quantitative targets for prescribing quality.
Highlights
Infections due to antibiotic-resistant microorganisms are increasing in prevalence and of growing global concern
Between 2000 and 2015, the global antibiotic consumption rate increased by almost 40%, and a major part of the increase was in low- and middle-income countries [3]
Misuse and overuse may be prevalent in hospital medicine, primary care or both, and clearly require different approaches to control and focussed quality improvement projects
Summary
Infections due to antibiotic-resistant microorganisms are increasing in prevalence and of growing global concern. The essential recommendations under the heading “Encouraging good practice in the use of antimicrobial agents” in this document were. Educational initiatives for both health professionals (human and animal) and the general public are of major importance for improving the use of antimicrobial agents. Antimicrobial teams (including infectious disease specialists, clinical microbiologists and other appropriate specialists) should be introduced in every hospital. They should have the authority to modify antimicrobial prescriptions of individual clinicians in accordance with locally accepted guidelines, always taking account of the needs of the patient.
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