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Challenges of Antimicrobial Stewardship Programs: What's a Steward to Do?

Goff, Debra A. PharmD, FCCP

Infectious Diseases in Clinical Practice: November 2011 - Volume 19 - Issue 6 - p 375
doi: 10.1097/IPC.0b013e318236df19
Editorial Comment

From the Ohio State University Medical Center Columbus, OH.

Correspondence to: Debra A. Goff, PharmD, FCCP, The Ohio State University Medical Center Columbus, OH. E-mail:

The author has no funding or conflicts of interest to disclose.

Written as an editorial commentary regarding Louie T. Antimicrobial Stewardship on pages 382-387 of the journal.

In 1986, an article in the Journal of Infectious Diseases declared that there was little need for more infectious disease experts.1 With the advent of safe and effective antibiotics in the 20th century, deaths from bacterial diseases became infrequent and were no longer considered a pressing medical problem. In 2011, there is a global crisis of antibiotic resistance, few new novel antimicrobials in the discovery pipeline, and not enough trained physicians or pharmacists in antimicrobial stewardship.2

The article by Louie3 in this issue of Infectious Diseases in Clinical Practice is a valuable review of some of the current issues faced by antimicrobial stewardship programs. He brings to light some of the recent changes in the state of California where stewardship is now required in all acute care hospitals. Although he does not discuss the specific requirements or how the state of California is enforcing or policing the policy, it is an interesting topic. It shows just how far the problem of escalating antimicrobial resistance has come since 1986.

The article describes antimicrobial stewardship as a program that oversees institutional antimicrobial use. Many concepts are described including restrictions, preauthorization, and postprescription review with feedback. In addition, he reviews specific stewardship initiatives including length of antibiotic use, de-escalation, adherence to national or local guidelines, and pharmacodynamic optimization of antibiotics.

New technology from the microbiology laboratory has assisted stewardship by making rapid diagnosis, thereby allowing the steward to rapidly implement effective therapy. Louie describes 2 examples with the steward making interventions that allowed for quicker use of appropriate antibiotics.

The steward's role is rapidly changing from one who oversees institutional antimicrobial use to one who evaluates new diagnostic tests, learns how to promote the program as a patient safety initiative, interacts with information technologist to assist with data collecting, creates a business plan and budget for the hospital's chief executive officer, and continues to educate. All of this is done with one person in mind: the patient. This article brings us up-to-date with what a steward should be doing.

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1. Petersdorf RG. Whither infectious diseases? Memories, manpower, and money. J Infect Dis. 1986;153(2):189-195.
2. Spellberg B, Guidos R. Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis. 2011;52(suppl 5):397-428.
3. Louie T. Antimicrobial stewardship: a review. Infect Dis Clin Pract (Baltim Md). 2011.
© 2011 Lippincott Williams & Wilkins, Inc.