Table 7.

Research priorities

Define thresholds to direct therapy decisions

Rationale There is no evidence to guide precise assessment definition of thresholds at which empirical therapy suggested in the hospital formulary and/or by the antimicrobial stewardship team should be changed. In addition to local resistance rates, important aspects to consider when deciding on antimicrobial therapy are the patient’s risk factors, severity of infection, access to antibiotics (which depends on the country) and setting (not only hospital versus community, but also different hospital wards). Considering that there is no solid evidence for a real threshold to adopt, the use of risk factors, severity of infection, setting and a patient-centred approach is the most reasonable strategy to direct therapy decisions and should be further explored.

Establish criteria for ranking antibiotics

Rationale A ‘ranking of antibiotics’ based on their ecological impact, PK/PD properties and toxicity can be a valuable tool to inform restrictive AMS intervention or to guide de-escalation. Selective reporting is a useful tool to drive the appropriate use of antimicrobial agents, but no criteria on which antibiotics should be concealed have been clearly defined. Studies on innovative strategies to identify standards for antibiotic classification and ranking for antimicrobial stewardship should be performed.

Develop stewardship guidelines for specific sub-settings

Rationale The available evidence in this field is not sufficient to provide recommendations by settings. Further research is needed to develop stewardship interventions adapted and validated for high-risk patients, specifically paediatrics and the immunocompromised.