Background Health care services must engage all relevant healthcare workers, including nurses, in optimal antimicrobial use to address the global threat of drug-resistant infections. Reflecting upon the variety of antimicrobial stewardship (AMS) nursing models already implemented in the UK could facilitate policymaking and decisions in other settings about context-sensitive, pragmatic nurse roles. Methods We describe purposefully selected cases drawn from the UK network of public sector nurses in AMS exploring their characteristics, influence, relations with clinical and financial structures, and role content. Results AMS nursing has been deployed in the UK within 'vertical', 'horizontal' or 'hybrid' models. The 'vertical' model refers to a novel, often unique consultant-type role ideally suited to transform organisational practice by legitimising nurse participation in antimicrobial decisions. Such organisational improvements may not be straightforward, though, due to scalability issues. The 'horizontal' model can foster coordinated efforts to increase optimal AMS behaviours in all nurses around a narrative of patient safety and quality. Such model may be unable to address tensions between the required institutional response to sepsis and the inappropriate use of antibiotics. Finally, the 'hybrid' model would increase AMS responsibilities for all nurses whilst allocating some expanded AMS skills to existing teams of specialists such as sepsis or vascular access nurses. This model can generate economies of scale, yet it may be threatened by a lack of clarity about a nurse-relevant vision. Conclusions A variety of models articulating the participation of nurses in antimicrobial stewardship efforts have already been implemented in public sector organisations in the UK. The strengths and weaknesses of each model need considering before implementation in other settings and healthcare systems, including precise metrics of success and careful consideration of context-sensitive, resource dependent and pragmatic solutions.

中文翻译：

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护士在抗菌药物管理中的作用：英国公共部门急症护理服务提供模式的经验教训。

背景 卫生保健服务必须让包括护士在内的所有相关卫生保健工作者参与最佳抗菌药物使用，以应对耐药感染的全球威胁。反思英国已经实施的各种抗菌药物管理（AMS）护理模式可以促进其他环境中有关情境敏感、务实的护士角色的政策制定和决策。方法 我们描述了从英国 AMS 公共部门护士网络中特意挑选的案例，探索其特征、影响、与临床和财务结构的关系以及角色内容。结果 AMS 护理已在英国以“垂直”、“水平”或“混合”模式部署。“垂直”模式是指一种新颖且通常独特的顾问型角色，非常适合通过使护士参与抗菌决策合法化来改变组织实践。然而，由于可扩展性问题，这种组织改进可能并不简单。“水平”模型可以促进协调一致的努力，以围绕患者安全和质量的叙述提高所有护士的最佳 AMS 行为。这种模型可能无法解决脓毒症所需的机构反应与抗生素的不当使用之间的紧张关系。最后，“混合”模式将增加所有护士的 AMS 职责，同时将一些扩展的 AMS 技能分配给现有的专家团队，例如脓毒症或血管通路护士。这种模式可以产生规模经济，但它可能会因护士相关愿景缺乏清晰度而受到威胁。结论 英国公共部门组织已经实施了多种阐明护士参与抗菌药物管理工作的模型。在其他环境和医疗保健系统中实施之前，需要考虑每个模型的优点和缺点，包括成功的精确衡量标准以及对上下文敏感、资源依赖和务实的解决方案的仔细考虑。