[Antimicrobial Stewardship in Daily Life - "Ask Your Doctor and Your Pharmacist"]. / Antibiotic Stewardship im Alltag ­ "Fragen Sie Ihren Arzt und Apotheker!".

Antimicrobial Stewardship (AMS) cannot be practised as a one-man show. A well-established AMS-team with formal authority and dedicated time given by the hospital management can manage its tasks also in exceptional situations as for example an outbreak due to a multi-drug-resistant pathogen. Know-how of clinical infectious diseases is mandatory for all members of the AMS-team. The AMS-team plays various roles in an outbreak situation with the rational use of last-resort antibiotics and optimization of the dosage by therapeutic drug monitoring being most important. Restrictive usage of antibiotics can decrease the antibiotic selection pressure and counteract with the development of new bacterial resistances. Usage of last-resort antibiotics in an outbreak situation leads to an exceptional increase of therapeutic costs with fewer patients at the same time. Interdisciplinary work of infection control, the AMS-team, the different clinical departments and the hospital management are important for the prevention and the management of outbreak situations due to multi-drug-resistant pathogens.

Antibiotic Stewardship-Visiten: Zeitverschwendung oder Qualitätssteigerung?

INTRODUCTION: One of the core strategies to optimize antiinfective therapy is to review antibiotic prescriptions. Therefore, Antibiotic Stewardship (ABS) team members either attend ward rounds or perform a chart review to provide feedback to and discuss with the attending physician. Acceptance and effectiveness of both options are discussed in this article. METHODS: Attending physicians were asked to complete a questionnaire evaluating ABS activities. The modality of the reviewing process and its effectiveness, as well as the feasibility of recommendations was assessed. As the degree of implementation of ABS recommendations decreased on a trauma ward, the reviewing process was changed from chart review to attending the daily ward rounds. In this setting, the duration of the reviewing process and the consumption of antiinfectives in recommended daily doses/100 patient days (RDD/100PT) were assessed, comparing the two intervention modalities. RESULTS: Attending physicians predominantly appreciated the modality and extent of ABS currently offered to them by the ABS team, rating it relevant and effective. Implementation of ABS recommendations was increased on the trauma ward by academic detailing during the daily ward round; the consumption of broad spectrum antibiotics was reduced. DISCUSSION: ABS team members with formal authority and dedicated time for antibiotic stewardship activities effectively optimize antiinfective therapies by reviewing antibiotic prescriptions. The interaction of ABS experts and attending physicians contributes fundamentally to the effectiveness and degree of implementation of ABS interventions.