Antimicrobial resistance is a known major public health issue, and antimicrobial stewardship, the appropriate use of antimicrobial agents, is critical to stemming the continued emergence of antimicrobial-resistant organisms.

The increasing recognition of the health burden associated with hospital-acquired infections in Canada and the increasing evidence that the use of antimicrobials in hospitals is a critical determinant of infection rates due to the most important hospital-acquired pathogens, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, emphasize the urgency of developing and facilitating antimicrobial stewardship programs in Ontario hospitals.

Literature has shown that appropriate use of antimicrobials can reduce occurrences of antibiotic resistant organisms. An antimicrobial stewardship project led by ISMP Canada for the province of Ontario is another knowledge translation project that comprised of multiple phases. In the first phase, a comprehensive survey was conducted to examine the current state of hospital-based antimicrobial stewardship practices in Ontario.

In the second phase, the project team convened an international consensus forum to determine and prioritize interventions that were considered to be appropriate and effective. The following six interventions were identified (in no particular order):

• Implement an Antimicrobial Stewardship Program at the hospital level
• Antimicrobial Stewardship Self-Assessment Tool
• Prospective audit with intervention and feedback at an individual patient and prescriber level
• Education/training needed to build antimicrobial stewardship capacity
• Data collection and feedback at an institutional or program level
• Tailoring antimicrobial therapy including de-escalation, streamlining and IV to PO switches.

The third phase proposes testing of these interventions in a representative sample of pilot hospitals and is currently under discussion.

• Antibiotic Consumption Calculator - ABC Calc 3.1 (2006)
• Anti-infective Guidelines for Community-acquired Infections (2012)

• Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
• Community-Acquired Pneumonia
• Surgical Prophylaxis
• Uncomplicated Urinary Tract Infection
• Ventilator-Associated Pneumonia

• IDSA/SHEA Guidelines for developing an Institutional Program to Enhance Antimicrobial Stewardship.
• PAACT - Community Antimicrobial Stewardship Program
• Do Bugs Need Drugs® is a community education program to address the problem of antibiotic resistance.
• Centers for Disease Control and Prevention (CDC) for the latest information about health risks, health data and statistics, funding opportunities and traveler's health.
• Infectious Diseases Society of America (IDSA) is a reference for physicians, scientists and other health care professionals who specialize in infectious diseases.
• European Study Group on Antibiotic Policies (ESGAP)
• European Centre for Disease Prevention and Control (ECDC)
• Antibiotic Strategies (ABS International) was a project created in September 2006 to assist hospitals in the member states of the "European Union" to implement antibiotic strategies for appropriate use of antibiotics.
• The European Antimicrobial Resistance Surveillance System (EARSS) is a European network providing reference data on antimicrobial resistance for public health purposes.

• WHO Collaborating Centre for Drug Statistics Methodology can be used to look up ATC codes and DDD values
• Ministry of Health and Long-Term Care, Health Data Branch can be used to look up the number of patient days at your hospital. Access requires a username and password. To request access, please see website for registration form (available after you have accepted the terms and conditions of use.
• Antibiotic Consumption Calculator - ABC Calc 3.1 (2006) ABC Calc is a simple computer tool to measure antibiotic consumption in hospitals and hospital wards. It transforms aggregated data provided by hospital pharmacies (generally as a number of packages or vials) into meaningful antibiotic utilisation rates. It was developed for the ESCMID Study Group on Antibiotic Policies (ESGAP) at the National Center for Antimicrobials and Infection Control, Statens Serum Institut (Copenhagen, Denmark), as part of the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP).
• Canadian ICD 10- CA Codes
• World Health Organization International Classification of Diseases (ICD)

• The Alliance for the Prudent Use of Antibiotics
• Association of Medical Microbiology and Infectious Disease Canada
• Canadian Bacterial Surveillance Network
• Canadian Committee on Antibiotic Resistance
• CAN-R Canadian Antimicrobial Resistance Alliance
• Public Health Agency of Canada (Infectious Diseases)
• Toronto Invasive Bacterial Diseases Network