ANTIMICROBIAL STEWARDSHIP - A STRATEGIC TASK IN INSTITUTIONAL AND NATIONAL HEALTHCARE

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. Conclusions: AS activities in Bulgaria should be broaden, better controlled and supported as official Governmental policy.