Antimicrobial resistance is recognised as one of the most important current public health problems. While multidrug-resistant pathogens have been spreading worldwide, no new antimicrobial drugs with novel mechanisms of action are expected to be available for clinical use in the coming years, which is particularly worrisome for the gram negatives.1,2 There are various reasons for the continuous emergence and rapid spread of resistant bacteria, including antibiotic overuse in humans, animals and agriculture, environmental and infection control issues. Antimicrobial use in humans, and particularly in hospitals, is frequently excessive and inappropriate. It is no longer possible to accept this situation without acting.
The rate of antimicrobial resistance among the main invasive pathogens is considerably high in Spain, and is similar to that in other southern countries in Europe.3 Comparative data for antibiotic consumption in Spanish hospitals in comparison with other European countries are lacking, but data from outpatients shows a high consumption rate in Spain.4 Even though some centres are very active in the field, a recent survey showed that the number of Spanish hospitals carrying out structured antibiotic stewardship activities was low,5 and another study showed that there is much room for improvement in the knowledge of our residents in the area of antimicrobial therapy.6
In recent years, something is changing in Spain in this area. In 2010, the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC; www.seimc.org) and the Spanish Network for Research on Infectious Diseases (REIPI; www.reipi.org) sponsored a monographic supplement of Enfermedades Infecciosas y Microbiología Clínica aimed at promoting the prudent use of antimicrobials and released a position paper.7 In 2012, the Study Group of Nosocomial Infections (GEIH) of SEIMC, the Spanish Society of Hospital Pharmacists (SEFH), and the Spanish Society of Preventive Medicine and Public Health and Hygiene (SEMPSPH) endorsed the PROA initiative, which includes a consensus document with structured recommendations for the implementation of antimicrobial stewardship programs,8 educational and scientific activities aimed at improving the education of the specialists who are part of the antibiotic teams in all Spanish hospitals (including this monographic supplement of Enfermedades Infecciosas y Microbiología Clínica), and hopefully, creating a network of antibiotic teams that can share their experiences and results.
But this is not enough. A cultural change among healthcare providers, authorities, and the population is needed to improve antimicrobial use in Spain as shown by the results of the Eurobarometer.9 The principles of appropriate antibiotic use must be incorporated as specific educational objectives in all Schools of Medicine and in the training of all medical specialists; antibiotic teams should be formed in all Spanish hospitals as specified in the PROA document;8 and antimicrobial stewardship objectives should be part of institutional objectives for the healthcare system. The involvement of National and Regional healthcare authorities is necessary so that antimicrobial stewardship becomes a public health priority. It is urgent. In this context, SEIMC and REIPI, in a policy of joining forces to improve the appropriate use of antimicrobials in Spain, have sponsored this supplement as a tool to develop the PROA initiative in Spain. We acknowledge the authors of articles included for their excellent work.
FundingThe authors receive funding for research from the Ministerio de Economía y Competitividad, Instituto de Salud Carlos III - co-financed by the European Development Regional Fund “A way to achieve Europe” ERDF, Spanish Network for Research on Infectious Diseases (REIPI RD12/0015).
Conflicts of interestThe authors declare that they have no conflicts of interest.
