News-Newsletter Vol. 29 No. 1

The Need for Antimicrobial Stewardship

Alfred DeMaria, M.D.
Medical Director and State Epidemiologist
Massachusetts Department of Public Health

Antimicrobial resistance in microorganisms is driven by exposure to antimicrobial agents, especially sub-inhibitory concentrations. This exposure results in natural selection of more resistant variants in the population. Thus, to the extent that antimicrobial agents can be used appropriately and judiciously, and in doses and delivery that reduce the likelihood of resistance emerging, antimicrobial resistance can be prevented or reduced. Likewise, it is exposure to antibiotics that precipitates disease due to Clostridium difficile by suppressing the normal bacterial flora of the bowel and providing a favorable environment for the germination, growth and toxin production that leads to C. difficile-associated diseases (CDAD). The appropriate, judicious and correct use of antimicrobial agents to prevent antimicrobial resistance and reduce the likelihood of resistance is referred to as “antimicrobial stewardship”.

Antimicrobial stewardship is designed to assure the most appropriate, effective treatment of infection while reducing emergence of resistance, C. difficile infection and other adverse events. These programs can also reduce costs by maximizing efficacy and minimizing costly complications. Antimicrobial stewardship is a structural approach to reducing undesirable outcomes that has deep roots, but emerged as a comprehensive approach in recent years driven by increasing resistance and the problem presented by CDAD. Some facilities have robust programs in place and many facilities are further developing antimicrobial stewardship programs. There is a need across the spectrum of healthcare provision for information on antimicrobial stewardship and the components of a comprehensive approach.

For more information, see related article and recommended resources. Also visit APUA’s website ( to read back issues of the APUA Newsletter Vol. 26 No. 2&3 "Infection control: a potent AMR containment strategy,” Vol. 26 No. 1, and Vol. 28 No. 1, “Urinary Tract Infections: Antibiotic Guidelines for a Global Problem”.


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