head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing
ISSN: 1312-773X (Online)
Issue: 2017, vol. 23, issue 4
Subject Area: Medicine
DOI: 10.5272/jimab.2017234.1808
Published online: 12 December 2017

Original article

J of IMAB 2017 Oct-Dec;23(4):1808-1812
Emma KeuleyanORCID logo Corresponding Autoremail,
Department Clinical Microbiology, Medical Institute – Ministry of the Interior, Sofia, Bulgaria.

Purpose: Antimicrobial stewardship (AS) is a consensus multidisciplinary activity aimed at better care for patients and containment of Antimicrobial resistance (AR). The purpose of this article is to characterize AS process in Bulgaria at  hospital and national level.
Material/Methods: Analysis of national AS activities was performed. AS program of the Medical Institute – Ministry of the Interior (MI) – is presented as a model of hospital implementation.
Results: In Bulgaria, the first National program for a rational antibiotic policy was developed in 2001, and National AR Surveillance system BulSTAR works since more than 15 years. Ministry of healthcare is the main regulator: hospital AS is mandatory and required for the process of hospital accreditations. At MI antibiotic policy program includes Guidelines for: - Empiric antibiotic therapy, - therapy by specialities, - Antibiotic prophylaxis in Surgery. According to the results of point prevalence survey Global PPS-2015, antibiotic use in MI was 24 %, quality indicators showed 100 % written reason for the use of antibiotics and tailoring to the microbiology result. Approaches in antimicrobials prescribing were similar to those of the other EU countries. However, the spectrum of the prescribed antibiotics was more limited and with higher usage of generic ceftriaxone. To improve the usage of antibiotics in Ambulatory care Guidelines were issued in 2016. It remains: to introduce National action plan for AS, with appropriate funding, staffing and control.
AS activities in Bulgaria should be broaden, better controlled and supported as official Governmental policy.

Keywords: hospital antibiotic policy, national antibiotic policy, Bulgaria,

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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Keuleyan E. Antimicrobial stewardship - a strategic task in institutional and national healthcare. J of IMAB. 2017 Oct-Dec;23(4):1808-1812. DOI: 10.5272/jimab.2017234.1808

Corresponding AutorCorrespondence to: Prof. Emma Keuleyan, PhD, Head, Clinical Microbiology Dept. Medical Institute – Ministry of the Interior; 79, Skobelev Blvd, 1606 Sofia, Bulgaria; E-mail: emma.keuleyan@gmail.com

1. Commission notice - EU Guidelines for the prudent use of antimicrobials in human health(2017/C 212/01). EC. Official Journal of the European Union. 2017. [Internet]
2. Antimicrobial resistance and causes of non-prudent use of antibiotics in human medicine in the EU. Ed. Paget J, Lescure D, Versporten A, Goossens H, Schellevis F, van Dijk L. European Union. 17 July 2017. [Internet]
3. WHO. Global Action Plan on Antimicrobial Resistance. 2015. [Internet]
4. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016 May 15;62(10):e51-77. [PubMed] [CrossRef]
5. Keuleyan E, Gould M. Key issues in developing antibiotic policies: from an institutional level to Europe-wide. European Study Group on Antibiotic Policy (ESGAP), Subgroup III. Clin Microbiol Infect. 2001; 7 Suppl 6:16-21. [PubMed] [CrossRef]
6. Levy Hara G, Kanj SS, Pagani L, Abbo L, Endimiani A, Wertheim HF, et al. Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy. Int J Antimicrob Agents. 2016 Sep;48(3):239-46. [PubMed] [CrossRef]
7. NICE. Antimicrobial stewardship. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NICE Medicines and prescribing centre, the UK, February 2015. [Internet]
8. de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection. 2016 Jun;44(3):395-439. [PubMed] [CrossRef]
9. Antimicrobial stewardship in Australian hospitals. M. Duguid, M. Cruickshank (eds.) Australian commission on safety and quality in healthcare. Sydney, Australia, 2011. [Internet]
10. Natwani D, Sneddon J. Practical Guide to Antimicrobial stewardship in hospitals. Biomerieux, 2015. [Internet]
11. Schuts EC, Hulscher ME, Mouton JW, Verduin CM, Stuart JW, Overdiek HW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infectious Diseases. 2016 Jul;16(7):847-56. [CrossRef]
12. Keuleyan EE. Bulgaria: Hospital Case Studies and National Antibiotiv Policy. In: Antibiotic resistance: synthesis of recommendations by expert policy groups. Alliance for the Prudent Use of Antibiotics Avorn JL, Barrett JF, Davey PG, McEwen SA, O’Brien TF, Levy SB, (Eds). WHO/CSR Web site. 2001.10. pp.140-146  [Internet]:
13. Keuleyan E, Kostyanev T. Antimicrobial Stewardship in Bulgaria. In:  Antimicrobial Stewardship. Editors: Pulcini C, Ergonul O, Can F, Beovic B. Vol. 2, 1st Edition, Elsevier Academic Press, 1st April 2017. Chapter 19.7:pp.259-61.
14. Summarized guidelines for rational use of antibiotics in society. Ministry of Health. National Center for Infectious and Parasitic Diseases. 2016. [in Bulgarian].
15. Howard P, Huttner B, Beovic B, Beraud G, Kofteridis DP, Pano Pardo J, et al. ESGAP inventory of target indicators assessing antibiotic prescriptions: a cross-sectional survey. J Antimicrob Chemother. 2017 Oct;72(10):2910-2914.
16. Le Coz P, Carlet J, Roblot F, Pulcini C. Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals. Med Mal Infect. 2016 Jun;46(4):200-6. [PubMed] [CrossRef]
17. Davey P. The 2015 Garrod Lecture: Why is improvement difficult? J Antimicrob Chemother. 2015 Nov;70(11):2931-44. [PubMed] [CrossRef]
18. Johnson AP, Muller-Pebody B, Budd E, Ashiru-Oredope D, Ladenheim D, Hain D, et al. Improving feedback of surveillance data on antimicrobial consumption, resistance and stewardship in England: putting the data at your Fingertips. J Antimicrob Chemother. 2017 Apr 1;72(4):953-56. [PubMed] [CrossRef]
19. Akpan MR, Ahmad R, Shebl NA, Ashiru-Oredope D. A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals. Antibiotics (Basel). 2016 Jan 13;5(1). [PubMed] [CrossRef]
20. Pollack LA, Plachouras D, Gruhler H, Sinkowitz-Cochran R, Monnet D, Weber JT. Summary of the modified Delphi process for common structure and process indicators for hospital antimicrobial stewardship programs. Transatlantic Taskforce on Antimicrobial Resistance (TATFAR). CDC. 2015; [Internet]
21. Retamar P, Rodrigues-Bano J, Paul M, Hussein K. AMS in an Era of Multidrug-Resistant Bacteria. In: C. Pulcini, O. Ergonul, F. Can, B. Beovic (Eds). Antimicrobial Stewardship. Vol. 2, 1st Edition, Elsevier Academic Press, 1st April 2017. Chapter 18: pp.219-232 .

Received: 06 September 2017
Published online: 12 December 2017

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