The term “antimicrobial stewardship” refers to a series of coordinated interventions, aimed to promote the appropriate use of antimicrobials and directs the optimal choice of drug, dose, and duration of therapy and the route of administration.

A coordinated and multidisciplinary management of antimicrobial therapy is now essential to achieve optimal clinical results, to minimize the toxicity and adverse events related to drugs, the health care costs, and limit the selection of resistant strains.

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It is necessary to adopt a management strategy of “antimicrobial stewardship,” reasoned on the basis of local clinical and epidemiological data from the organizations involved in the management of infections from MDR (Multi-Drug Resistant) bugs.

To date, there is no universal implementation of antimicrobial stewardship protocols, such as protocols of management or post-discharge surveillance of patients colonized or infected with MDR pathogens. So far, several nations including Italy haven’t standardized multicenter and multi-regional programs of antimicrobial stewardship.

One of the most important purposes of ALARICO project is the definition and dissemination of shared protocols and multidisciplinary antimicrobial stewardship, which include:

• The active surveillance of the risk for de novo of colonization by a pathogenic MDR strain
• Recommendations about the use of antimicrobial molecules, dosage, time and methods of administration
• Sharing of clinical experiences and epidemiological data among centers participating to the project located in different geographic areas.

Super-bugs: what doesn’t kill… make stronger them!

Super-bugs are microorganisms with multiple mechanism of resistance to the majority of the existing antimicrobials. The phenomenon of antimicrobial resistance is a global problem, with multiple relevant clinical and public health implications.

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Bacteria are simple but highly specialized organisms, with the ability to adapt to environment by changing their metabolism and acquiring genes, which allow them to become resistant to the activity of antimicrobial drugs.

During the “pre-antibiotic era” there was a risk of dying over a simple infection like a wound, a bite, or pneumonia…

From the ’50s onwards, there has been a continuous and impetuous antibiotics production, with discoveries of new classes of antimicrobials that have allowed an increasingly wide spectrum therapy. Unfortunately, the synthesis of new antibiotic drugs has been rapidly associated with the emergence of antibiotic-resistance.

Nowadays we are facing with some microorganisms, the so-called super-bugs, resistant to almost all antibiotics available on the market. This worrisome phenomenon is highlighted by the fact that the discovery of new drugs is delayed and the new classes of antibiotics will only be available in the foreseeable future.

“Bad bugs, no drugs”. What would happen if “post-antibiotic era” began?

Jim O’Neill estimates, in the report on the social and political resistance to antibiotics consequences, that in 2050 about 10 million people worldwide will die of a multi-resistant germs infection, exceeding the number of deaths caused by other highly fatal diseases like cancer, diabetes and accidents (report by Jim O’Neill).

Without antibiotics we would not have the ability to perform major surgery, organ transplants or stem cells, we may use medical devices, such as pacemakers, prosthetic heart valves, orthopedic implants, or practices such as invasive diagnostic and therapeutic procedures that are routine today.

The determining factors for the development of antimicrobial resistance are, on the one hand, the inappropriate use in medicine and antibiotic selective pressure exerted on community hospitals, and on the other hand, the massive use of antibiotics, such as for example, in agriculture and animal farms.

It is estimated that up to 50% of antibiotic prescriptions are inappropriate or in terms of recommendation or the dosage and duration of therapy.