Guarding the Goods: an Introduction to Antimicrobial Stewardship

The emergence of antimicrobial resistance and the clinical challenges associated with it are formidable obstacles to providing quality health care in the 21st century (Bartlett, Clin. Infect. Dis. 53[Suppl. 1], S4-S7, 2011). Antibiotic stewardship programs (ASPs) serve as a crucial component of a multi-faceted response to this problem. In 2007, the Society for Healthcare Epidemiology of America and Infectious Disease Society of America released consensus guidelines for the creation of ASPs (Dellit et al., Clin. Infect. Dis. 44:159-177, 2007). The primary strategies employed by ASPs include formulary restriction and antimicrobial order review with feedback to providers. There are also multiple secondary strategies that work in tandem with these, including the use of antibiotic order forms, clinical practice algorithms, conversion from parenteral to oral therapy, de-escalation of therapy, dose optimization, education, and the use of computer-assisted decision support software. Other components necessary to ensure the ASP's success include recruiting key personnel, the support of the hospital administration, integration with the clinical microbiology laboratory, and well-defined program goals and metrics (Dellit et al., Clin. Infect. Dis. 44:159-177, 2007).