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Global Health Econ Sustain Antimicrobial resistance control model

change of the antimicrobials might be genuinely needed, applicable to different patients’ demographic determinants
such as a dose optimization, a switch from parenteral to oral based on the available data from previous clinical
antimicrobials, or a radical stop. All these options depend microbiology laboratory analyses. This can further
on the clinical severity and the patient’s comorbidities. The strengthen AMS implementation.
pharmacokinetics and pharmacodynamics not only of the
antimicrobials but also of the other prescribed medications 4.2. Unit/Ward-centered epidemiology
can affect the prospective oral antimicrobials. The essence The approach of AMS can be determined by the unit/
of this switch is to limit many untoward consequences ward of the patient. More antimicrobials are consumed
from a parenteral medication, including phlebitis (a by patients in dependent wards or intensive care units,
cause for more protracted antimicrobial use). The clinical favoring the emergence of AMR (Odih et al., 2022). AMS
microbiologist is usually saddled with the responsibility strategies can be predicted based on the prevalence of
of implementing this change or switches most of the AMR in such units from previously collated data. AMS
time. Of the multiple antimicrobials the pathogen is can be implemented by either formulary restriction/pre-
susceptible to (in the antibiogram), an oral formulation authorization or prospective audit of the antimicrobial
of similar antimicrobial activity or the oral drug in the used. Other units or wards may implement AMS, which is
same antimicrobial class as the parenteral medication is based on their patients’ rate of device use.
preferred. This is usually instituted after the acute phase
of the disease state and after an extensive review of the 4.3. Disease-centered epidemiology
patient’s clinical state. Identifying the rate of occurrence of infectious disease(s)
in the health institution can also determine the trend of
4. Hospital epidemiology in AMS the AMS approach. For facilities with a high prevalence of

Hospital epidemiology takes pre-eminence from the data particular infectious diseases such as antibiotic-associated
management perspective in clinical microbiology specialty. diarrhea, the AMS approach will require the health facility
Hospital epidemiology gives a pictorial representation to reserve the medications that have propensities of
of the laboratory assessment and its impacts on patients’ triggering the disease based on the previous data collated in
health. Hospital epidemiology encompasses a program the clinical microbiology laboratory. The syndrome-specific
of surveillance for healthcare-associated infections diagnostic algorithms by the United Kingdom give a disease-
(HAI), which include central line-associated bloodstream centered epidemiologic approach to laboratory testing (UK
infections, catheter-associated urinary tract infections, Standards for Microbiology Investigations: Searchable
surgical site infection (SSI), and Clostridiodes difficile Index, 2022). In addition, a selective reporting style should
infection (Yale School of Medicine, 2023). This HAI be adopted in the clinical microbiology laboratory to
surveillance could be patient-centered, unit/ward-centered, suppress selected antimicrobials in antibiograms based on
disease-centered, and pathogen-centered. A few notable the AMS strategy in use while targeting a prevalent disease
parameters for measurement include the length of hospital in the health facility (Wu et al., 2023).
stay, acquisition of HAI, acquisition of antimicrobial-
resistant pathogen, cost of antimicrobials during hospital 4.4. Pathogen-centered epidemiology
stay, and development of adverse reactions. Biostatistical The most prevalent pathogens in the health facilities
analysis of these data revealed that a modification or a should be known across the different disease spectra
redesign of the implementation of the AMS strategies with a more detailed antimicrobial susceptibility profile
to suit the needs of the health institution is required. (i.e., cumulative antibiogram). This analysis would assist
Epidemiologic tracking can be made feasible using an the AMS program in strategizing the approach to limit
array of laboratory surveillance analytical tools, such as the the use of such antimicrobials. For instance, the rising
WHONET (WHONET, 2023) or a similar locally adaptable incidence of carbapenem-resistant microorganisms in a
tool. health institution will require restricting carbapenems
to certain extent. In another case, the identification of
4.1. Patient-centered epidemiology certain organisms which may possess abilities to develop

In assessing the effects of disease entities and the effects antimicrobial-resistant patterns under exposure to some
of the antimicrobials on the outcomes, the patient’s antibiotics must be noted (Macdougall, 2011, Kohlmann
demographic stratification can help categorize the extent of et al., 2018). In such a case, such a group of antimicrobials
AMS in using antimicrobials. These include the age groups should be carefully dispensed if the frequency of
of the patients, immune status of patients, occupation. identification of such pathogens in the health facility is
Hospital epidemiology can stratify different antimicrobials high.

Volume 2 Issue 1 (2024) 5 https://doi.org/10.36922/ghes.1783