Antimicrobial Stewardship Principles and Implementation

Core Principles and Definition

The primary goal of antimicrobial stewardship is to improve patient outcomes while minimizing the unintended consequences of antimicrobial use, including adverse events, selection of pathogenic organisms, and emergence of resistance, as recommended by the Infectious Diseases Society of America 2
Antimicrobial stewardship programs (ASPs) aim to optimize clinical outcomes while minimizing adverse events including Clostridium difficile infections, reducing antimicrobial resistance, and optimizing resource utilization across the continuum of care, according to the Infectious Diseases Society of America 1
Appropriate antimicrobial prescribing requires following the "5Ds of stewardship": right diagnosis, drug, dose, duration, and de-escalation, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 2

Leadership by infectious disease physicians with additional stewardship training, partnered with clinical pharmacists with infectious disease expertise, is essential for effective ASPs, as recommended by the Society for Healthcare Epidemiology of America 1, 3
Implementation of preauthorization and/or prospective audit and feedback interventions as primary strategies is a strong recommendation with moderate-quality evidence, according to the Infectious Diseases Society of America 1

Prospective audit and feedback on antimicrobial prescriptions with real-time intervention to optimize antibiotic use is a key strategy, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 3, 4
Formulary restriction and preauthorization to control use of specific antimicrobials is an effective approach, according to the Infectious Diseases Society of America 1

Tracking antimicrobial utilization patterns and resistance trends is crucial for evaluating ASP effectiveness, as recommended by the Centers for Disease Control and Prevention 3
Monitoring appropriateness of antibiotic therapy choice, rehospitalization rates, and time to culture review provides important metrics, according to the Society for Healthcare Epidemiology of America 3, 4