The landscape of antimicrobial stewardship is fraught with challenges, particularly for outpatient settings that often lack the necessary resources to support such initiatives. This distinct disparity is underscored by the fact that large hospitals and medical systems, with access to substantial staff, equipment, and funding, can efficiently implement and maintain antimicrobial stewardship programs, while outpatient clinics, burdened with resource constraints, grapple with implementing them.
In 2013, American outpatient pharmacies dispensed roughly 269 million antibiotic prescriptions, highlighting the critical role these settings play in antibiotic administration. Further, about 20% of pediatric visits and 10% of adult consultations in outpatient environments result in an antibiotic prescription. This immense responsibility is often performed without significant support, making it a challenging task.
The World AMR Congress held in Philadelphia uplifted the issue further when Kevin Nguyen, PharmD, BCIDP at St. Christopher’s Hospital for Children in Philadelphia, offered a presentation called ‘From Bedside to Clinic: Navigating the Landscape of Antimicrobial Stewardship Challenges.’ Nguyen emphasized the resource disparity stating that about 80-90% of antibiotics are used in outpatient settings, yet the majority of resources are dedicated to inpatient care.
He intimated the urgent need for a resource shift towards outpatient clinics, which could bolster their capacities, especially from a stewardship perspective. Nonetheless, even when resources are allocated, the professionals working in these clinics are often unprepared to implement stewardship effectively, causing a significant disconnect.
Highlighting the disparity, Nguyen pointed out that outpatient providers are eager to provide stewardship and optimize patient care; however, their efforts are hindered due to inadequate infrastructure and resources.
Fortunately, innovative programs and third-party companies make efforts to bridge this gap, providing a glimmer of hope for a future where antimicrobial stewardship is a ubiquitous practice across all healthcare sectors, irrespective of their size, location, or patient demographic.