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Implementing an antimicrobial stewardship program in out-patient dialysis units

Cunha, Cheston B.; D’Agata, Erika M.C.

Current Opinion in Nephrology and Hypertension: November 2016 - Volume 25 - Issue 6 - p 551–555
doi: 10.1097/MNH.0000000000000281
DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Mario Rubin

Purpose of review Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant gram-negative bacteria, continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns. The purpose of this review is to highlight the key elements and interventions of ASP.

Recent findings The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.

Summary Developing and implementing an ASP by following key elements and interventions in the out-patient dialysis setting can lead to reduced mortality, adverse events, costs, and improvement in antimicrobial susceptibility rates.

Division of Infectious Diseases, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA

Correspondence to Erika M.C. D’Agata, MD, MPH, Brown University, Alpert Medical School, 593 Eddy Street, Providence, RI, USA. Tel: +1 617 721 4415; e-mail:

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