• Antibiotic-Preserving Strategies Must Be Implemented to Battle Resistance

    Modern medicine is largely dependent on the efficacy of antibiotics and other antimicrobials.  Yet, the ability to treat infections successfully with antibiotics is hampered by resistance due to their overuse and misuse.  Well-documented and properly coordinated strategies like stewardship of antibiotics, expanded surveillance of antibiotic resistance, as well as investment in new drug development and diagnostic testing can work to reverse this alarming trend.  The Society for Healthcare Epidemiology of America (SHEA) is pleased to join the Centers for Disease Control and Prevention (CDC) and other partners in "Get Smart about Antibiotics Week" to raise awareness of strategies and programs to address antibiotic resistance.

  • Antimicrobial Stewardship

    Antibiotic stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs.

  • Antimicrobial Stewardship: Guidelines

    SHEA has partnered with IDSA for over a decade to develop treatment guidelines and programmatic recommendations for antimicrobial stewardship.

  • Antimicrobial Stewardship: Implementation Tools & Resources

    This section provides additional resources for individuals interested in antimicrobial stewardship programs, including Materials and Forms, US Academic Medical Centers Online Stewardship Resources, International Online Stewardship Resources, and Other Resources.  Please note that these resources are not endorsed by SHEA and are shared for informational purposes only.  If you have resources to add, please send them to info@shea-online.org.  Note: Inclusion in this list does not indicate endorsement by SHEA.

  • Antimicrobial Stewardship: Other Organizations and Programs

    Below are examples of antimicrobial initiatives underway in other organizations, institutions, state and federal agencies, and internationally.

  • Antimicrobial Stewardship: Research

    The SHEA Research Network invites investigators to submit research proposals focused on antimicrobial stewardship.  Investigators interested in engaging the Network for a study should complete the Study Proposal Concept Form and submit it to SRN@shea-online.org or fax: (703) 684-1009.

  • Antimicrobial Use in Long-Term Care Facilities

    There is intense antimicrobial use in long-term-care facilities, and studies repeatedly document that much of this use is inappropriate. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and virtual absence of relevant clinical trials. This article recommends approaches to management of common LTCF infections and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the article acknowledges the unique aspects of provision of care in the LTCF.

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  • Clinical Practice Guidelines for CDI in Adults and Children: 2017 Update

    IDSA and SHEA update to the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults, incorporating recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment) and significant changes in the management of CDI reflecting the evolving controversy over best methods for diagnosis. This evidence-based guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

    Authors: McDonald LC, Gerding D, Johnson S, Bakken J, Carroll K, Coffin S, Dubberke E, Garey K, Gould C, Kelly C, Loo V, Sammons JS, Sandora T, Wilcox M

    Full text: https://doi.org/10.1093/cid/cix1085

    Partial update January 2021.

  • Guidance for the Knowledge and Skills Required for Antimicrobial Stewardship Leaders

    Antimicrobial stewardship (AS) refers to coordinated interventions to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration. The objectives of antimicrobial stewardship are to achieve the best clinical outcomes related to antimicrobial use while minimizing emergence of antimicrobial resistant organisms, Clostridium difficile infection, and other adverse events and reducing excessive costs attributable to suboptimal antimicrobial use.

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  • Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship

    This document presents guidelines for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy. The combination of effective antimicrobial stewardship with a comprehensive infection control program has been shown to limit the emergence and transmission of antimicrobial‐resistant bacteria and reduce healthcare costs without adversely impacting quality-of-care. These guidelines focus on the development of effective hospital‐based stewardship programs and do not include specific outpatient recommendations. The population targeted includes all patients in acute care hospitals.

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  • Guidelines for the Prevention of Antimicrobial Resistance in Hospitals

    Antimicrobial resistance results in increased morbidity, mortality, and costs of healthcare. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. 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. A comprehensively applied infection control program will interdict the dissemination of resistant strains.

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  • Implementing an Antibiotic Stewardship Program

    IDSA and SHEA evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care, with recommendations that address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.

    Authors: Barlam T, Cosgrove S, Abbo L, MacDougall C, Schuetz A, Septimus E, Srinivasan A, Dellit T, Falck-Ytter Y, Fishman N, Hamilton C, Jenkins T, Lipsett P, Malani P, May L, Moran G, Neuhauser M, Newland J, Ohl C, Samore M, Seo S, Trivedi K

    Full text: https://doi.org/10.1093/cid/ciw118

    Chinese translation: Part IPart IIPart IIIPart IV

  • Medicare and Medicaid Programs; Hospital and Critical Access Hospital (CAH) Changes To Promote Innovation, Flexibility, and Improvement in Patient Care [CMS-3295-P]

    The Society for Healthcare Epidemiology of America provided comments both individually and with The Infectious Diseases Society of America (IDSA) in response to the proposed rule, “Hospital and Critical Access Hospital (CAH) Changes To Promote Innovation, Flexibility, and Improvement in Patient Care,” within the Medicare and Medicaid programs, commonly referred to as the “Conditions of Participation (CoPs).”   The individual comments SHEA submitted respond to changes in infection prevention provisions and clarifications needed in the final rule.  The joint comments SHEA submitted with IDSA  focus on the antibiotic stewardship portion of the proposed rules.

    SHEA  Comments Addressing Infection Prevention (878 KB)
    SHEA & IDSA Joint Comments Addressing Antibiotic Stewardship (432 KB)

  • Moving Toward Elimination of Healthcare-Associated Infections: A Call to Action

    A framework for achieving elimination of HAIs using successful preventive practices and public health strategies to achieve the goal of eliminating HAIs builds upon the basis of lessons from recent successes and require constant action and vigilance. These are: implement evidence-based practices that protect patients; align incentives to promote system-wide strategies for HAI prevention; address gaps in knowledge to push beyond the current medical knowledge; and collect data to target prevention efforts and to measure progress.

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  • National Strategy to Combat Antibiotic-Resistant Bacteria

    On September 18, 2014, the Obama Administration released a coordinated effort related to antimicrobial resistance and stewardship. The links to the key materials released are below. Expect to see more from SHEA on antimicrobial stewardship as we focus on our strategy moving forward. Several SHEA members were on the President's Council of Advisors on Science and Technology (PCAST) and we are pleased that their expertise and leadership on this critical issue was recognized. As of March 2015, the White House released a National Action Plan for Combatting Antibiotic-Resistant Bacteria.  SHEA continues to follow and provide input on this plan.

  • Pediatric Antimicrobial Stewardship Resources

    Pediatric Antimicrobial Stewardship is just as if not more important than adult stewardship program. These resources are specific for pediatric use.

  • Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America

    Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States.

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  • Policy World Alliance Against Antibiotic Resistance (WAAAR) declaration against antibiotic resistance

    SHEA has signed on as a medical society supporting the efforts of WAAAR, a group of 700 individuals from 55 different countries representing all the key stakeholders (physicians, veterinarians, microbiologists, surgeons, pharmacists, nurses, evolutionary biologists, ecologists, environmentalists, patient advocacy groups). The primary goal of WAAAR is to raise awareness about the urgency and magnitude of the antibiotic resistance threat and to promote an international dialogue to assist in effective responses. The Alliance is dedicated to actively promoting antibiotic preservation and to raising awareness among antibiotic prescribers, politicians and policy-makers, patient safety and advocacy groups, the pharmaceutical industry, international health organizations, and the general population. Please read the declaration to find out more about this effort.

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  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship—Observational Studies

    Observational studies compare outcomes among subjects with and without an exposure of interest, without intervention from study investigators. Observational studies can be designed as a prospective or retrospective cohort study or as a case-control study. In healthcare epidemiology, these observational studies often take advantage of existing healthcare databases, making them more cost-effective than clinical trials and allowing analyses of rare outcomes. This paper addresses the importance of selecting a well-defined study population, highlights key considerations for study design, and offers potential solutions including biostatistical tools that are applicable to observational study designs.

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  • Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Randomized Controlled Trials

    Randomized controlled trials (RCT) produce the strongest level of clinical evidence when comparing interventions. RCTs are technically difficult, costly, and require specific considerations including the use of patient- and cluster-level randomization and outcome selection. In this methods paper, we focus on key considerations for RCT methods in healthcare epidemiology and antimicrobial stewardship (HE&AS) research, including the need for cluster randomization, conduct at multiple sites, behavior modification interventions, and difficulty with identifying appropriate outcomes. We review key RCTs in HE&AS with a focus on advantages and disadvantages of methods used. A checklist is provided to aid in the development of RCTs in HE&AS

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  • Research Methods Series in Healthcare Epidemiology and Antimicrobial Stewardship

    Research in healthcare epidemiology and antimicrobial stewardship is rapidly expanding with the involvement of researchers from varied countries and backgrounds. Researchers must use scientific methods that will provide the strongest evidence to advance healthcare epidemiology, but there are limited resources for information on specific aspects of healthcare epidemiology and antimicrobial stewardship research or easy ways to access examples of studies using specific methods. In response to this need, the SHEA Research Committee has developed a series of white papers on research methods. The objective of this series is to promote rigorous healthcare epidemiology research by summarizing critical components, practical considerations, and pitfalls of commonly used research methods:

    • Introduction
      Morgan DJ, Safdar N, Milstone AM, Anderson DJ. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship. Infection Control & Hospital Epidemiology. Cambridge University Press; 2016;37(6):627–628.
    • Observational Studies
      Snyder GM, Young H, Varman M, Milstone AM, Harris AD, Munoz-Price S. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship—Observational Studies. Infection Control & Hospital Epidemiology. Cambridge University Press; 2016;37(10):1141–1146.
    • Randomized Control Trials
      Anderson DJ, Juthani-Mehta M, Morgan DJ. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Randomized Controlled Trials. Infection Control & Hospital Epidemiology. Cambridge University Press; 2016;37(6):629–634.