Improving patient-related infection outcomes in response to increasing rates of antimicrobial resistance

Widespread antimicrobial exposures through both healthcare and environmental usage have contributed to an increase in antimicrobial-resistant infections. These infections are associated with poorer patient outcomes. Strategies to better use antimicrobials and optimise patient outcomes are collectively termed antimicrobial stewardship. Here, the author presents their research on improving antimicrobial stewardship strategies to enhance patient-related infection outcomes in response to the increasing rates of antimicrobial resistance.

The first theme focuses on the author’s work in applying antimicrobial stewardship in practice. The author has introduced a novel support system into clinical practice to improve the efficiencies of antimicrobial services. Other work includes generating new evidence to support better antimicrobial prescribing in patients presenting with acute kidney injury or viral pneumonitis. These research findings have supported novel approaches to managing patients with infections.

The second theme focuses on strategies to optimise available antimicrobials to meet the challenge of emerging antimicrobial resistance. Here, novel therapies or dosing regimens are tested in clinical settings to generate evidence for their use. For emerging resistant pathogens, the author has published a systematic review and national treatment recommendations for these challenging-to-treat infections. This work has been adopted across the infection network to improve available treatment options.

In the third theme, the author shares published work focusing on safer antimicrobial prescribing. These include minimising antimicrobial treatment durations through tailored treatment courses using the latest evidence base and novel diagnostic tools (e.g., procalcitonin). Work is also presented on describing common adverse effects of common antimicrobials and how these may be minimised for future prescribing. This work has informed local and national projects to make antimicrobial prescribing safer for future patients.

This thesis provides published evidence on how to better use antimicrobials in response to the emerging threat of antimicrobial-resistant infections with local and national impact on prescribing practices and patient outcomes.