Antimicrobial Stewardship and Antimicrobial Resistance | Figure 1

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Key Points:

Antimicrobial stewardship programs over the years have had several goals, including reducing costs, optimizing therapeutic outcomes, and reducing antimicrobial resistance. Reductions of antimicrobial resistance have been the most elusive.
The relationship between antimicrobial usage and resistance is also not always direct, especially with molecular mechanisms that confer resistance to multiple classes of antibiotics or through transferable plasmids and transposons that contain multiple resistance genes.
The understanding of which techniques are most effective is limited by the fact that many studies are descriptive or quasiexperimental.
More recently, several meta-analyses or systematic reviews of stewardship programs have been published, offering encouragement that some interventions, especially those that involve prospective auditing and feedback, have the effect of reducing overall antimicrobial selective pressure and are associated with infection control interventions, which can have an important impact on resistance rates in individual institutions.

Article by Louis B Rice, MD
Medical Clinics of North America (Volume 102, Issue 5, September 2018, Pages 805-818)