One Health antimicrobial resistance: stewardship in Australia
Laura Y. Hardefeldt
A * and Karin Thursky B
A
B
Dr Laura Hardefeldt is a senior lecturer at The University of Melbourne. Her research interests are in antimicrobial use, antimicrobial stewardship and antimicrobial resistance in the veterinary sector and in a One Health context. She is at the forefront of veterinary antimicrobial stewardship research nationally and internationally. |
Prof. Karin Thursky is an infectious disease physician and clinical researcher at the Royal Melbourne Hospital, Peter MacCallum Cancer Centre and The University of Melbourne. She has played a pioneering role in the development of antimicrobial stewardship in the Australian health system and the national antimicrobial resistance strategy and is a renowned leader in antimicrobial stewardship internationally. |
Abstract
Antimicrobial stewardship (AMS) is promoted as a core set of actions that aim to mitigate the emergence of antimicrobial resistance, but to also ensure safety and quality use of antimicrobials. By improving the appropriate use of antimicrobials we can improve patient care, reduce adverse effects and perhaps slow the emergence of antimicrobial resistance. However, changing behaviour of prescribers is challenging, with barriers and facilitators often common across diverse prescribing groups – doctors and veterinarians. Many of the physical challenges facing prescribers are also shared and lessons can be learned about implementation of interventions between groups. In this article we discuss qualitative and quantitative research, and interventions in AMS, in Australia from a One Health perspective.
Keywords: AMR, AMS, antibiotic, antimicrobial resistance, antimicrobial stewardship, behaviour, digital health, implementation, veterinary.
Dr Laura Hardefeldt is a senior lecturer at The University of Melbourne. Her research interests are in antimicrobial use, antimicrobial stewardship and antimicrobial resistance in the veterinary sector and in a One Health context. She is at the forefront of veterinary antimicrobial stewardship research nationally and internationally. |
Prof. Karin Thursky is an infectious disease physician and clinical researcher at the Royal Melbourne Hospital, Peter MacCallum Cancer Centre and The University of Melbourne. She has played a pioneering role in the development of antimicrobial stewardship in the Australian health system and the national antimicrobial resistance strategy and is a renowned leader in antimicrobial stewardship internationally. |
References
1 O’Neill J (2016) Tackling drug-resistant infections globally: final report and recommendations. The Wellcome Trust and Her Majesty’s Government, London, UK. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
2 Australian Commission on Safety and Quality in Health Care (2021) AURA 2021: fourth Australian report on antimicrobial use and resistance in human health. ACSQHC, Sydney, NSW, Australia. https://www.safetyandquality.gov.au/sites/default/files/2021-09/aura_2021_-_report_-_final_accessible_pdf_-_for_web_publication.pdf
3 Australian Commission on Safety and Quality in Health Care (2019) AURA 2019: third Australian report on antimicrobial use and resistance in human health. ACSQHC, Sydney, NSW, Australia. https://www.safetyandquality.gov.au/sites/default/files/2019-06/AURA-2019-Report.pdf
4 Manski-Nankervis JA et al. (2018) A need for action: results from the Australian General Practice National Antimicrobial Prescribing Survey (GP NAPS). Society for Academic Primary Care. https://sapc.ac.uk/conference/2018/abstract/need-action-results-australian-general-practice-national-antimicrobial
5 Teoh L et al. (2023) Exploring the appropriateness of antibiotic prescribing for dental presentations in Australian general practice – a pilot study. Br J Clin Pharmacol 89, 1554-1559.
| Crossref | Google Scholar | PubMed |
6 Hardefeldt LY et al. (2017) Antimicrobial prescribing in dogs and cats in Australia: results of the Australasian Infectious Disease Advisory Panel survey. J Vet Intern Med 31, 1100-1107.
| Crossref | Google Scholar | PubMed |
7 Hardefeldt LY et al. (2017) Cross-sectional study of antimicrobials used for surgical prophylaxis by bovine veterinary practitioners in Australia. Vet Rec 181, 426.
| Crossref | Google Scholar | PubMed |
8 Hur B et al. (2022) Evaluating the dose, indication and agreement with guidelines of antimicrobial use in companion animal practice with natural language processing. JAC Antimicrob Resist 4, dlab194.
| Crossref | Google Scholar | PubMed |
9 Department of Health and Aged Care and Department of Agriculture, Fisheries and Forestry (2021) One Health Master Action Plan for Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond. Commonwealth of Australia. https://www.amr.gov.au/resources/one-health-master-action-plan-australias-national-antimicrobial-resistance-strategy-2020-and-beyond
10 James R et al. (2015) A mixed methods study of the barriers and enablers in implementing antimicrobial stewardship programmes in Australian regional and rural hospitals. J Antimicrob Chemother 70, 2665-2670.
| Crossref | Google Scholar | PubMed |
11 Rzewuska M et al. (2020) Barriers and facilitators to implementation of antibiotic stewardship programmes in hospitals in developed countries: insights from transnational studies. Front Sociol 5, 41.
| Crossref | Google Scholar | PubMed |
12 Hardefeldt LY et al. (2018) Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices. J Vet Intern Med 32, 1092-1099.
| Crossref | Google Scholar | PubMed |
13 Bishop JL et al. (2019) Qualitative study of the factors impacting antimicrobial stewardship programme delivery in regional and remote hospitals. J Hosp Infect 101, 440-446.
| Crossref | Google Scholar | PubMed |
14 Biezen R et al. (2019) Dissonant views – GPs’ and parents’ perspectives on antibiotic prescribing for young children with respiratory tract infections. BMC Fam Pract 20, 46.
| Crossref | Google Scholar | PubMed |
15 Scarborough RO et al. (2023) ‘Brave enough’: a qualitative study of veterinary decisions to withhold or delay antimicrobial treatment in pets. Antibiotics 12, 540.
| Crossref | Google Scholar | PubMed |
16 Saha SK et al. (2020) A nationwide survey of Australian general practitioners on antimicrobial stewardship: awareness, uptake, collaboration with pharmacists and improvement strategies. Antibiotics 9, 310.
| Crossref | Google Scholar | PubMed |
17 Davis M et al. (2024) Risk individualisation and moral injury in the treatment of infection as impediments to the tackling of antimicrobial resistance. Health Risk Soc 1-18.
| Crossref | Google Scholar |
18 Ierano C et al. (2019) Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals. PLoS ONE 14, e0225011.
| Crossref | Google Scholar | PubMed |
19 Thursky KA et al. (2021) Antimicrobial stewardship in Australia: the role of qualitative research in programme development. JAC Antimicrob Resist 3, dlab166.
| Crossref | Google Scholar | PubMed |
20 Australian Commission on Safety and Quality in Health Care (2020) Antimicrobial Stewardship Clinical Care Standard. ACSQHC, Sydney, NSW, Australia. https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard
21 Bishop JL et al. (2021) Impact of time to first antimicrobial dose on length of stay and 30-day hospital readmission in patients with lower limb cellulitis. J Glob Antimicrob Resist 25, 367-369.
| Crossref | Google Scholar | PubMed |
22 Dyar OJ et al. (2017) What is antimicrobial stewardship? Clin Microbiol Infect 23, 793-798.
| Crossref | Google Scholar | PubMed |
23 Buising KL et al. (2008) Electronic antibiotic stewardship – reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. J Antimicrob Chemother 62, 608-616.
| Crossref | Google Scholar | PubMed |
24 Chua KYL et al. (2021) The Penicillin Allergy Delabeling Program: a multicenter whole-of-hospital health services intervention and comparative effectiveness study. Clin Infect Dis 73, 487-496.
| Crossref | Google Scholar | PubMed |
25 James R et al. (2022) The feasibility and generalizability of assessing the appropriateness of antimicrobial prescribing in hospitals: a review of the Australian National Antimicrobial Prescribing Survey. JAC Antimicrob Resist 4, dlac012.
| Crossref | Google Scholar | PubMed |
26 Hardefeldt LY et al. (2022) Antimicrobial stewardship in companion animal practice: an implementation trial in 135 general practice veterinary clinics. JAC Antimicrob Resist 4, dlac015.
| Crossref | Google Scholar |
28 Bishop JL et al. (2020) Sustainability of antimicrobial stewardship programs in Australian rural hospitals: a qualitative study. Aust Health Rev 44, 415-420.
| Crossref | Google Scholar | PubMed |
30 Biezen R et al. (2021) Evaluating the implementation of a pilot quality improvement program to support appropriate antimicrobial prescribing in general practice. Antibiotics 10, 867.
| Crossref | Google Scholar | PubMed |
31 Hawes L et al. (2018) Use of electronic medical records to describe general practitioner antibiotic prescribing patterns. Aust J Gen Pract 47, 796-800.
| Crossref | Google Scholar | PubMed |
32 Hur BA et al. (2020) Describing the antimicrobial usage patterns of companion animal veterinary practices; free text analysis of more than 4.4 million consultation records. PLoS ONE 15, e0230049.
| Crossref | Google Scholar | PubMed |
33 The National Centre for Antimicrobail Stewardship (2022) MRFFRD000113: appropriate antimicrobial use: scaling surveillance using digital health. NCAS. https://www.ncas-australia.org/digital-health-research-data-infrastructure.
34 Coombe P (2023) Antimicrobial Stewardship in Australian Livestock Industries. 3rd edn. Animal Industries Antimicrobial Stewardship RD&E Strategy. https://aiasrdestrategy.com.au/wp-content/uploads/2023/12/AMS-Report-2023-v3.pdf
35 Australian Beef Sustainability Framework (2022) Annual update 2022. ABSF. https://www.sustainableaustralianbeef.com.au/globalassets/beef-sustainability/documents/absf_update_2022_web.pdf
