Antimicrobial agents can also have direct toxic effects on people and animals, including damage to kidneys, endocrine glands, liver, teeth and bones.
[6] In 1966, the first systematic assessment of antibiotic use in the Winnipeg, Manitoba, Canada general hospital was published: Medical records were reviewed during two non-consecutive four-month periods (medicine, psychiatry, urology, gynecology and surgery, orthopedics, neurosurgery, ear, nose and throat, and ophthalmology).
[citation needed] The term AMS was coined in 1996 by two internists at Emory University School of Medicine, John McGowan and Dale Gerding, a specialist on C. difficile.
"[11] In 1997, SHEA and the Infectious Diseases Society of America published guidelines to prevent antimicrobial resistance arguing that "…appropriate antimicrobial stewardship, that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms.
"[12] Ten years later, in 2007, bacterial, antiviral and antifungal resistance had risen to such a degree that the CDC rang the alarm [citation needed].
This Executive Order charged a Task Force to develop a 5-Year action plan that included steps to reduce the emergence and spread of antibiotic-resistant bacteria and ensure continued availability of effective therapies for infections.
The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) was formed in response to this Executive Order.
[19] On January 1, 2017 Joint Commission regulations went into effect detailing that hospitals should have an AMS team consisting of infection preventionist(s), pharmacist(s), and a practitioner to write protocols and develop projects focused on the appropriate use of antibiotics.
[20] Effective January 1, 2020, the Joint Commission antimicrobial stewardship requirements were expanded to outpatient health care organizations as well.
The entire committee may include physician representatives, who are top antimicrobial prescribers such as physicians in intensive care medicine, Hematology -Oncology, cystic fibrosis clinicians or hospitalists, a microbiologist, a quality improvement (QI) specialist, and a representative from hospital administration.
[29] An ASP has the following tasks, in line with quality improvement theory: Parts of the baseline assessment are to: In hospitals and clinics using electronic medical records, information technology resources are crucial to focusing on these questions.
Further tasks are: In 2010, two pediatric infectious disease physicians suggested to look at the following variables to judge the outcome of AMS interventions:[34] When examining the relationship between an outcome and an intervention, the epidemiological method of time series analysis is preferred, because it accounts for the dependence between time points.
At issue is how feedback is presented to prescribers, individually, in aggregate, with or without peer comparisons, and whether to reward or punish.