Global Antimicrobial Stewardship: Challenges and Successes from Frontline Stewards

The current global overuse and misuse of antimicrobials requires an urgent international response. According to the 2014 World Health Organization (WHO) Antimicrobial Resistance Global Report on Surveillance, deaths per year due to antibiotic resistance are reported as high as 23,000 in the United States, 25,000 in the European Union, 38,000 in Thailand and 58,000 in India [1]. The WHO developed a Global Action Plan in May 2015 mandating member states to produce national strategic plans to combat antimicrobial resistance by establishing a global development and antibiotic stewardship framework [2]. Many countries have successfully implemented antimicrobial stewardship programs in the hospital setting while several limited resource countries continue to struggle with getting stewardship programs up and running. The art of antimicrobial stewardship (AMS) is an evolving discipline. The articles in this themed issue aim to provide the reader with an overview of successful antimicrobial stewardship programs from 6 different countries; the United States, United Kingdom, South Africa, Singapore, Australia, and Italy. The authors discuss the international role of pharmacists in AMS. Included in this issue are two studies from South Africa and Singapore and four reviews of stewardship efforts with a description of the pharmacist’s role. The issue starts with a study by Messina et al. from South Africa, a resource-limited country. This prospective multi-center pharmacist-driven study aimed to improve the ‘‘hangtime’’ of antibiotics defined as the time elapsed from the written antibiotic order to actual intravenous administration. Pharmacists from 33 hospitals evaluated and intervened on 32,985 patients over a 60-week study period and significantly improved ‘‘hangtime compliance from 41.2% to 78.4%. The success of this D. A. Goff Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA