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Antimicrobial use in Australian hospitals: how much and how appropriate?

Antimicrobial agents play a central role in modern health care, especially in the hospital setting. Many of the modern advances in health care such as intensive care, neonatal care, cancer chemotherapy, complex surgery and prosthetic joint replacement depend on the ongoing effectiveness of antimicrobials. However, antimicrobial resistance (AMR) has emerged in the most common and important pathogens, and as resistances have accumulated, multiresistant strains have arisen. The impact of resistance and multiresistance is being felt worldwide.1

In Australian hospitals, some multiresistant organisms were epidemic and have now become endemic in many facilities, particularly those delivering tertiary and quaternary care. Much of this resistance is driven by hospital antimicrobial use. Because antimicrobials are necessary for providing safe care in hospitals, questions arise about what factors in antimicrobial use may be adjusted in order to deliver both low levels of resistance and low prevalence of multiresistant organisms. Factors to consider include relationships between volumes of antimicrobials used and AMR; patterns of use and AMR; and appropriateness of prescribing.

The Australian Commission on Safety and Quality in Health Care (the Commission) has produced a range of resources regarding antimicrobial stewardship, now considered to be the most effective tool in promoting rational antimicrobial use.…