DOI QR코드

DOI QR Code

Principles and practices of antimicrobial stewardship programs in Korea

  • Ki Tae Kwon (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Shin-Woo Kim (Department of Internal Medicine, School of Medicine, Kyungpook National University)
  • Received : 2023.11.08
  • Accepted : 2024.01.07
  • Published : 2024.05.01

Abstract

This review addresses the escalating challenge posed by antibiotic resistance, highlighting its profound impact on global public health, including increased mortality rates and healthcare expenditures. The review focuses on the need to adopt the One Health approach to effectively manage antibiotic usage across human, animal, and environmental domains. Antimicrobial stewardship programs (ASPs) are considered as comprehensive strategies that encompass both core and supplementary initiatives aimed at enhancing prudent antibiotic use. The 2021 "Guidelines on Implementing ASP in Korea" introduced such strategies, with a strong emphasis on fostering multidisciplinary and collaborative efforts. Furthermore, the "Core Elements for Implementing ASPs in Korean General Hospitals," established in 2022, provide a structured framework for ASPs, delineating leadership responsibilities, the composition of interdisciplinary ASP teams, a range of interventions, and continuous monitoring and reporting mechanisms. In addition, this review examines patient-centric campaigns such as "Speak Up, Get Smart" and emphasizes the pivotal role of a multidisciplinary approach and international cooperation in addressing the multifaceted challenges associated with antibiotic resistance.

Keywords

References

  1. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51-e77. https://doi.org/10.1093/cid/ciw118
  2. World Health Organization. Antimicrobial resistance [Internet]. Geneva: World Health Organization, c2021 [cited 2023 Nov 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
  3. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022;399:629-655. https://doi.org/10.1016/S0140-6736(21)02724-0
  4. Kim YA, Park YS, Youk T, Lee H, Lee K. Trends in South Korean antimicrobial use and association with changes in Escherichia coli resistance rates: 12-year ecological study using a nationwide surveillance and antimicrobial prescription database. PLoS One 2018;13:e0209580.
  5. Kim YA, Park YS, Youk T, Lee H, Lee K. Changes in antimicrobial usage patterns in Korea: 12-year analysis based on database of the National Health Insurance Service-National Sample Cohort. Sci Rep 2018;8:12210.
  6. Cunha CB. Antimicrobial stewardship programs: principles and practice. Med Clin North Am 2018;102:797-803. https://doi.org/10.1016/j.mcna.2018.04.003
  7. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159-177. https://doi.org/10.1086/510393
  8. World Health Organization. Global action plan on antimicrobial resistance [Internet]. Geneva: World Health Organization, c2015 [cited 2023 Nov 8]. Available from: https://www.who.int/publications/i/item/9789241509763.
  9. O'Neill J. Review on antimicrobial resistance (AMR): tackling drug-resistant infections globally: final report and recommendations [Internet]. London: AMR Review, c2016 [cited 2023 Nov 8]. Available from: https://amr-review.org/.
  10. World Bank. Drug-resistant infections: a threat to our economic future [Internet]. Washington (DC): World Bank, c2017 [cited 2023 Nov 8]. Available from: https://openknowledge.worldbank.org/handle/10986/26707.
  11. Organisation for Economic Co-operation and Development. Stemming the superbug tide: Just a few dollars more [Internet]. Paris: OECD, c2018 [cited 2023 Nov 8]. Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/stemming-the-superbug-tide_9789264307599-en.
  12. World Health Organization. Health and economic impacts of antimicrobial resistance in the Western Pacific Region, 2020-2030 [Internet]. Geneva: World Health Organization, c2023 [cited 2023 Nov 8]. Available from: https://www.who.int/publications/i/item/9789290620112.
  13. Song KH, Kim CJ, Choi NK, et al. Clinical and economic burden of bacteremia due to multidrug-resistant organisms in Korea: a prospective case control study. J Glob Antimicrob Resist 2022;31:379-385. https://doi.org/10.1016/j.jgar.2022.11.005
  14. Hersh AL, King LM, Shapiro DJ, Hicks LA, Fleming-Dutra KE. Unnecessary antibiotic prescribing in US ambulatory care settings, 2010-2015. Clin Infect Dis 2021;72:133-137.
  15. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016;315:1864-1873. https://doi.org/10.1001/jama.2016.4151
  16. Kim YC, Park JY, Kim B, et al. Prescriptions patterns and appropriateness of usage of antibiotics in non-teaching community hospitals in South Korea: a multicentre retrospective study. Antimicrob Resist Infect Control 2022;11:40.
  17. Park SY, Moon SM, Kim B, et al. Appropriateness of antibiotic prescriptions during hospitalization and ambulatory care: a multicentre prevalence survey in Korea. J Glob Antimicrob Resist 2022;29:253-258. https://doi.org/10.1016/j.jgar.2022.03.021
  18. Park SY, Kim YC, Lee R, et al. Current status and prospect of qualitative assessment of antibiotics prescriptions. Infect Chemother 2022;54:599-609. https://doi.org/10.3947/ic.2022.0158
  19. Ryu S. The new Korean action plan for containment of antimicrobial resistance. J Glob Antimicrob Resist 2017;8:70-73. https://doi.org/10.1016/j.jgar.2016.10.013
  20. Hwang S, Kwon KT. Core elements for successful implementation of Antimicrobial Stewardship Programs. Infect Chemother 2021;53:421-435. https://doi.org/10.3947/ic.2021.0093
  21. Cheong HS, Park KH, Kim HB, et al. Core elements for implementing antimicrobial stewardship programs in Korean general hospitals. Infect Chemother 2022;54:637-673. https://doi.org/10.3947/ic.2022.0171
  22. Yoon YK, Kwon KT, Jeong SJ, et al. Guidelines on implementing antimicrobial stewardship programs in Korea. Infect Chemother 2021;53:617-659. https://doi.org/10.3947/ic.2021.0098
  23. Kim Y, Chae J, Shin S, et al. Trends in national pharmaceutical expenditure in Korea during 2011 - 2020. Infect Chemother 2023;55:237-246. https://doi.org/10.3947/ic.2023.0028
  24. Kim B, Kim YC, Kim HS, Park SY, Choi JY. Significance of the regular publication of statistics on national health indicators in academic journals and the prospects of Korea National Antimicrobial Use Analysis System (KONAS). Infect Chemother 2023;55:306-307. https://doi.org/10.3947/ic.2023.0060
  25. Park SY, Kim YC, Moon SM, et al. Developing a framework for regular and sustainable qualitative assessment of antibiotic use in Korean medical institutions: a Delphi study. Antimicrob Resist Infect Control 2023;12:114.
  26. Liu C, Yoon EJ, Kim D, et al. Antimicrobial resistance in South Korea: a report from the Korean global antimicrobial resistance surveillance system (Kor-GLASS) for 2017. J Infect Chemother 2019;25:845-859. https://doi.org/10.1016/j.jiac.2019.06.010
  27. Kim B, Kim J, Kim SW, Pai H. A survey of antimicrobial stewardship programs in Korea, 2015. J Korean Med Sci 2016;31:1553-1559. https://doi.org/10.3346/jkms.2016.31.10.1553
  28. Kim B, Lee MJ, Moon SM, et al. Current status of antimicrobial stewardship programmes in Korean hospitals: results of a 2018 nationwide survey. J Hosp Infect 2020;104:172-180. https://doi.org/10.1016/j.jhin.2019.09.003
  29. Park SY, Chang HH, Kim B, et al. Human resources required for antimicrobial stewardship activities for hospitalized patients in Korea. Infect Control Hosp Epidemiol 2020;41:1429-1435. https://doi.org/10.1017/ice.2020.1234
  30. Lee MJ, Moon SM, Kim B, et al. Status of antimicrobial stewardship programmes in Korean hospitals including small to medium-sized hospitals and the awareness and demands of physicians: a nationwide survey in 2020. J Glob Antimicrob Resist 2021;26:180-187. https://doi.org/10.1016/j.jgar.2021.06.001
  31. Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. How does medical policy on the use of prophylactic antibiotics affect medical costs, length of hospital stay, and antibiotic use in orthopedics? Yonsei Med J 2023;64:213-220. https://doi.org/10.3349/ymj.2022.0546
  32. Kim BN, Kim HB, Oh MD. Antibiotic control policies in South Korea, 2000-2013. Infect Chemother 2016;48:151-159. https://doi.org/10.3947/ic.2016.48.3.151
  33. Cho S, Kim C, Kim SH. et al. Institutional-specific smartphone application as a supplemental tool for an antimicrobial stewardship program in 2 large community-based hospitals: Acceptance of physicians and pharmacists. J Am Pharm Assoc (2003) 2023;63:967-975.e1. https://doi.org/10.1016/j.japh.2023.02.007
  34. Cheong HS, Park KH, Kim B, et al. Developing core elements and checklist items for implementing antimicrobial stewardship programs in Korean general hospitals: a modified Delphi survey. Infect Chemother 2023;55:59-68. https://doi.org/10.3947/ic.2022.0169
  35. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs [Internet]. Atlanta (GA): Centers for Disease Control and Prevention, c2021 [cited 2023 Nov 8]. Available from: https://www.cdc.gov/antibiot-ic-use/core-elements/hospital.html.
  36. Velazquez-Meza ME, Galarde-Lopez M, Carrillo-Quiroz B, Alpuche-Aranda CM. Antimicrobial resistance: One Health approach. Vet World 2022;15:743-749. https://doi.org/10.14202/vetworld.2022.743-749
  37. World Health Organization. One Health approach to AMR mitigation and safer food in the Asia-Pacific Region. Geneva:
  38. Mesa Varona O, Chaintarli K, Muller-Pebody B, et al. Monitoring antimicrobial resistance and drug usage in the human and livestock sector and foodborne antimicrobial resistance in six European countries. Infect Drug Resist 2020;13:957-993. https://doi.org/10.2147/IDR.S237038
  39. Kim S, Kim H, Kim Y, Kim M, Kwak H, Ryu S. Antimicrobial resistance of Escherichia coli from retail poultry meats in Korea. J Food Prot 2020;83:1673-1678. https://doi.org/10.4315/JFP-20-150
  40. Kim DW, Cha CJ. Antibiotic resistome from the One-Health perspective: understanding and controlling antimicrobial resistance transmission. Exp Mol Med 2021;53:301-309. https://doi.org/10.1038/s12276-021-00569-z
  41. Hong JS, Song W, Park HM, et al. Clonal spread of extended-spectrum cephalosporin-resistant Enterobacteriaceae between companion animals and humans in South Korea. Front Microbiol 2019;10:1371.
  42. Demirjian A, Sanchez GV, Finkelstein JA, et al. CDC grand rounds: getting smart about antibiotics. MMWR Morb Mortal Wkly Rep 2015;64:871-873. https://doi.org/10.15585/mmwr.mm6432a3
  43. The Joint Commision. Antibiotics-know the facts [Internet]. Oakbrook Terrace (IL): The Joint Commision, c2019 [cited 2023 Nov 8]. Available from: https://www.jointcommission.org/resources/for-consumers/speak-up-campaigns/antibiotics-know-the-facts.
  44. Lee H, Yoon EJ, Kim D, et al. Antimicrobial resistance of major clinical pathogens in South Korea, May 2016 to April 2017: first one-year report from Kor-GLASS. Euro Surveill 2018;23:1800047.
  45. Kim D, Yoon EJ, Hong JS, et al. Major bloodstream infection-causing bacterial pathogens and their antimicrobial resistance in South Korea, 2017-2019: phase I report from Kor-GLASS. Front Microbiol 2022;12:799084.
  46. Yam ELY, Hsu LY, Yap EP, et al. Antimicrobial resistance in the Asia Pacific region: a meeting report. Antimicrob Resist Infect Control 2019;8:202.
  47. Gochez D, Raicek M, Pinto Ferreira J, Jeannin M, Moulin G, Erlacher-Vindel E. OIE annual report on antimicrobial agents intended for use in animals: methods used. Front Vet Sci 2019;6:317.
  48. Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011;52:1232-1240. https://doi.org/10.1093/cid/cir063
  49. Nedved A, Lee BR, Hamner M, Wirtz A, Burns A, El Feghaly RE. Impact of an antibiotic stewardship program on antibiotic choice, dosing, and duration in pediatric urgent cares. Am J Infect Control 2023;51:520-526. https://doi.org/10.1016/j.ajic.2022.07.027
  50. Oliver NT, Skalweit MJ. Outpatient parenteral antibiotic therapy in older adults. Infect Dis Clin North Am 2023;37:123-137. https://doi.org/10.1016/j.idc.2022.09.002
  51. Heo E, Choi Y, Kim HS, et al. Current status of outpatient parenteral antimicrobial therapy in Korea: experience of a single university-affiliated acute-care hospital. Infect Chemother 2023;55:185-193.