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What is Antimicrobial Stewardship and why is it important?

​​​What is Antimicrobial Stewardship?

Antimicrobial stewardship is the practice of using anti-infectives (antibiotics, antifungals, antivirals) appropriately for the treatment of infections; this involves selecting the best anti-infective, the right dose, route, frequency and duration.

Why is It Important to Use Anti-Infectives Appropriately?​

The emergence of multi-drug resistant organisms is becoming a global concern; inappropriate or over usage of anti-infectives accelerates th​e emergence and spread of these organisms. By the same token, responsible use of anti-infectives is essential to preserve their potency for future generations.

In summary, optimal anti-infective therapy leads to:

  • Improvement in patient health outcomes
  • Decrease in adverse drug effects
  • Reduction in infections with antibiotic-resistant organisms (such as Clostridium difficile)
  • Prevention of drug resistance and preservation of anti-infectives
  • Reduction in health care costs​

ASPIRES Anti-Infective Prescription Audit and Feedback Services


Audit and Feedback is an evidence-based practice of reviewing a patient’s anti-infective therapy with the prescriber to optimize treatment. This involves the selection of the most appropriate, narrowest antibiotic based on indication, clinical status, allergies, adverse effects, and culture and susceptibility results in compliance with clinical practice guidelines.​

Anti-infective Prescription Audit and Feedback at VGH

The Anti-infective Prescription Audit and Feedback programme started on the Clinical Teaching Unit (CTU) wards at VGH in March of 2013 and expanded to other wards in August of 2013. ASPIRES clinical team at VGH (Drs. Jennifer Grant and Tim Lau) reviews the profiles of patients on targeted antibiotics and makes recommendations to optimize therapy when needed. The recommendations are delivered verbally through discussions with the clinical teams or via ASPIRES consult notes placed in Patient charts.

The following are antibiotics that are targeted by ASPIRES:​

  • Broad-spectrum antibiotics targeted for narrowing of spectrum: Carbapenems, Ceftazidime, Daptomycin, Linezolid, Piperacillin-tazobactam, Tigecycline, and Vancomycin​
  • IV antibiotics with PO bioequivalence targeted for conversion: Ciprofloxacin, Clindamycin, Moxifloxacin, Cotrimoxazole, and Metronidazole

Anti-infective Prescription Audit and ​Feedback at RH

The Prospective Audit and Feedback started at RH in June of 2014. The RH clinical team, Drs. Jerry Vortel and Sandra Chang, have developed a target list of antibiotics and patient selection criteria for their Audit and Feedback services and an electronic patient screening report has been set up to identify patients for further review. The RH clinical team reviews patients meeting the criteria and when needed optimizes therapy through discussions with attending physicians and/or leaving chart notes.

Anti-inf​​​ective Prescription Audit and Feedback at LGH

ASPIRES and LGH Pharmacy commenced Audit and Feedback services at LGH in October of 2013. The LGH clinical pharmacist team (Isla Drummond and Dr. Gabriel Loh) assesses patients and makes recommendations to optimize antibiotic therapies according to treatment guidelines. The ASPIRES physician reviews the complicated cases with LGH clinical pharmacists over the phone on a weekly basis. To better facilitate the expansion and sustainment of Audit and Feedback at LGH the ASPIRES clinical pharmacist (Dr. Tim Lau) provides weekly onsite consultations (started in June 2014) at LGH.​​​

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