Skip to main content

The Legislative Momentum of Antimicrobial Stewardship: the US Perspective

Current Treatment Options in Infectious Diseases volume 8, pages 93–101 (2016)Cite this article

Opinion statement

The aim of this review is to describe new and evolving legislation concerning antimicrobial stewardship at both the state and national level.

Antimicrobial resistance is a challenge to health worldwide. Recently, the US federal government has issued reports recognizing it as a serious threat to public health and national security acknowledging the need for judicious antimicrobial use. California has been a pioneer in mandating and implementing antimicrobial stewardship initiatives in healthcare institutions. With the White House Executive Order 13676, a number of healthcare organizations have committed to making antimicrobial stewardship policy and regulatory changes, and it will likely soon be mandatory for all states to comply with a newly created set of standards relating to antimicrobial stewardship in US hospitals and nursing homes.

With numerous changes, including governmental and organizational mandates, on the horizon, it is crucial for healthcare institutions to understand and be prepared for this new era in antimicrobial stewardship. The adoption of these new standards by institutions is of an imminent nature.

Key Points:• United States federal agencies and the executive branch have recently issued reports characterizing antimicrobial resistance as threats to public health and national security.• The state of California has implemented regulations requiring the establishment of antimicrobial stewardship programs (ASPs) in all acute-care hospitals and long-term care facilities.• A goal of the National Action Plan for Combating Antimicrobial Resistance is establishment of ASPs in acute care hospitals.• Veterans Affairs and Department of Defense facilities have already adopted the ASP requirement; for non-federal hospitals, this mandate will likely be achieved through regulators such as the Centers for Medicaid and Medicare Services.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Spellberg B, Guidos R, Gilbert D. Infectious Diseases Society of America. Antimicrobial stewardship as a medicare condition of participation. Clin Infect Dis. 2008;46:155–64.

    Article  PubMed  Google Scholar 

  2. Boucher T, Talbot G, Bradley J, Edwards J, Gilbert D, Rice L, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:1–12.

    Article  PubMed  Google Scholar 

  3. World Health Organization. Antimicrobial resistance: global report on surveillance. 2014; Available at: http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1. Accessed July 2015.

  4. Infectious Diseases Society of America. Bad Bus, No Drugs. 2004; Available at: http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Advancing_Product_Research_and_Development/Bad_Bugs_No_Drugs/Statements/As%20Antibiotic%20Discovery%20Stagnates%20A%20Public%20Health%20Crisis%20Brews.pdf. Accessed July 2015.

  5. U.S. Food and Drug Administration. New FDA task force will support innovation in antibacterial drug development. 2012; Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm320643.htm. Accessed July 22 2015.

  6. Forsyth C. Repairing the antibiotic pipeline: can the GAIN Act do it? Wash J Law Technol Arts. 2013;9:1–18.

    Google Scholar 

  7. Centers for Disease Control and Prevention. Checklist for core elements of hospital antibiotic stewardship programs. 2014; Available at: http://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf. Accessed July 2015. This publication provides useful guidance in the development and implementation of hospital antimicrobial stewardship programs.

  8. Cosgrove S, Hermsen E, Rybak M, File TJ, Parker S, Barlam T. Guidance for the knowledge and skills required for antimicrobial stewardship leaders. Infect Control Hosp Epidemiol. 2014;35:1444–51.

    Article  PubMed  Google Scholar 

  9. Dellit T, Owens R, McGowan J. 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;44:159–77.

    Article  PubMed  Google Scholar 

  10. Davey P, Brown E, Charani E. Interventions to Improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013;30, CD003543.

    Google Scholar 

  11. Pogorzelska-Maziarz M, Herzig C, Larson E, Furuya E, Perencevich E, Stone P. Implementation of antimicrobial stewardship policies in U.S. hospitals: findings from a national survey. Infect Control Hosp Epidemiol. 2015;36:261–4.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Trivedi K, Dumartin C, Gilchrist M, Wade P, Howard P. Identifying best practices across three countries: hospital antimicrobial stewardship in the United Kingdom, France, and the United States. Clin Infect Dis. 2014;59(S3):S170–8.

    Article  PubMed  Google Scholar 

  13. Nagel J, Stevenson J, Eiland E3, et al. Demonstrating the value of antimicrobial stewardship programs to hospital administrators. Clin Infect Dis. 2014;59:S146–53.

    Article  PubMed  Google Scholar 

  14. California Legislative Counsel. Senate Bill No. 739. 2006:1–8.

  15. California Department of Public Health. The California Antimicrobial Stewardship Program Initiative. 2015; Available at: http://www.cdph.ca.gov/programs/hai/Pages/antimicrobialStewardshipProgramInitiative.aspx. Accessed July 2015. This resource details California’s initiatives to promote statewide antimicrobial stewardship.

  16. Goldstein E, Trivedi K. Antimicrobial Stewardship: the view from California. Infect Dis Clin Pract. 2012;20:294–6.

    Article  Google Scholar 

  17. Trivedi K, Rosenberg J. The state of antimicrobial stewardship programs in California. Infect Control Hosp Epidemiol. 2015;34:379–84.

    Article  Google Scholar 

  18. California Legislative Counsel. Senate Bill No. 361. Antimicrobial stewardship: education and policies. 2015; Available at: http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB361. Accessed Oct 2015.

  19. Fridkin S, Baggs J, Fagan R. Vital signs: improving antibiotic use among hospitalized patients. Morb Mortal Wkly Rep (MMWR). 2014;63:194–200.

    Google Scholar 

  20. Mortensen E, Trivedi K, Rosenberg J, et al. Multidrug-resistant Acinetobacter baumanii infection, colonization, transmission related to a long-term care facility providing subacute care. Infect Control Hosp Epidemiol. 2014;35:406–11.

    Article  PubMed  Google Scholar 

  21. California Legislative Counsel. Senate Bill No. 1311 Hospitals: antimicrobial stewardship. 2014:1–2.

  22. Centers for Disease Control and Prevention. Get smart: know when antibiotics work. 2014; Available at: http://www.cdc.gov/getsmart/healthcare/. Accessed July 2015.

  23. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States. 2013; Available at: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed July 2015.

  24. President’s Council of Advisors on Science and Technology. Report to the president on combating antibiotic resistance. Sept 2014; Available at: https://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf. Accessed August 2015. Excellent high-level summary of issues regarding antimicrobial resistance and its management.

  25. Executive Order 13676: combating antibiotic-resistant bacteria. Sep 2014; Available at: http://www.gpo.gov/fdsys/pkg/FR-2014-09-23/pdf/2014-22805.pdf. Accessed August 2015.

  26. National action plan for combating antibiotic-resistant bacteria. Mar 2015; Available at: https://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Accessed August 2015. This document provides step-by-step guidance to healthcare organizations and agencies for decreasing antimicrobial resistance by the year 2020.

  27. Neuhauser M, Roselle G. VA’s antimicrobial stewardship program. 2014; Available at: http://www.blogs.va.gov/VAntage/13770/vas-antimicrobial-stewardship-program/. Accessed July 2015

  28. Department of Veterans Affairs. Antimicrobial stewardship programs (ASP). Veterans Health Administration Directive 1031. 2014; Available at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2964. Accessed July 2015.

  29. Graber C, Geffen D, Jones M. Association of antimicrobial stewardship activities with acute care antimicrobial usage at Veterans Affairs (VA) medical centers, 2012 [abstract 687]. Oral Presentation. IDSA Annual Meeting. San Diego, October 9, 2015.

  30. Centers for Medicare and Medicaid Servics. Fact sheets: CMS final rule to improve quality of care during hospital inpatient stays. 2013; Available at: http://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2013-08-02-3.html. Accessed July 2015.

  31. Infectious Diseases Society of America. U.S. Stakeholder Forum on Antimicrobial Resistance. ID Week, Philadelphia. 2014; Available at: http://s-far.org/wp-content/uploads/2015/08/S-FAR-Inaugural-Meeting-Summary-of-Proceedings_Final.pdf. Accessed Oct 2015.

  32. Infectious Diseases Society of America. Antimicrobial stewardship as a Medicare condition of participation. 2014; Available at: http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Advancing_Product_Research_and_Development/Antimicrobials/Letters/AS-IDSA-SHEA-CMS-CoP-Letter%20MAR_2014.pdf. Accessed Oct 2015.

  33. Centers for Medicare and Medicaid Services. Reform of requirements for long-term care facilities (CMS-3260-P). 2015; Available at: https://www.federalregister.gov/articles/2015/07/16/2015-17207/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities#h-4. Accessed Oct 2015.

  34. Zhani E. Joint Commission joins White House effort to reduce antibiotic overuse. 2015; Available at: http://www.jointcommission.org/joint_commission_joins_white_house_effort_to_reduce_antibiotic_overuse/. Accessed July 2015.

  35. National Quality Forum. Antibiotic stewardship action team. 2015; Available at: http://www.qualityforum.org/News_And_Resources/Press_Releases/2015/NQF_Launches_Antibiotic_Stewardship_Initiative.aspx. Accessed Oct 2015.

Download references

Acknowledgments

Kristi Kuper, PharmD and Arjun Srinivasan, MD

Author information

Authors and Affiliations

  1. Clinical Pharmacy Specialist, Infectious Diseases, Memorial Hospital, 2525 de Sales Avenue, Chattanooga, TN, 37404, USA

    Linda S. Johnson PharmD

  2. University of California San Francisco School of Pharmacy, 533 Parnassus Ave, U-585, Box 0622, San Francisco, CA, 94143-0622, USA

    Conan MacDougall PharmD, MAS

  3. Trivedi Consults, LLC, 1563 Solano Avenue, #443, Berkeley, CA, 94707, USA

    Kavita K. Trivedi MD

Authors
  1. Linda S. Johnson PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Conan MacDougall PharmD, MAS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kavita K. Trivedi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Conan MacDougall PharmD, MAS.

Ethics declarations

Conflict of Interest

Dr Linda S. Johnson declare that she has no conflict of interest.

Dr Conan MacDougall declare that he has no conflict of interest.

Dr Kavita K. Trivedi declare that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

Additional information

This article is part of the Topical Collection on Antimicrobial Stewardship

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Johnson, L.S., MacDougall, C. & Trivedi, K.K. The Legislative Momentum of Antimicrobial Stewardship: the US Perspective. Curr Treat Options Infect Dis 8, 93–101 (2016). https://doi.org/10.1007/s40506-016-0076-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40506-016-0076-6

Keywords

  • Antimicrobial stewardship
  • National legislation
  • Centers for medicare and medicaid services