Antibiotic Stewardship

Antimicrobial stewardship is the coordinated use of antibiotics in a way that gives the patient the best clinical outcome with the least avoidable harm. The prescriber and stewardship team choose the agent, dose, route, and duration that fit the suspected infection; the nurse makes that plan safer and more accurate at the bedside. Stewardship is not withholding treatment to save money. It is not asking a patient with sepsis to wait. It is preventing unnecessary exposure while delivering necessary therapy without delay. An antibiotic does not manufacture resistance because a patient takes it. Exposure creates selection pressure. Susceptible bacteria die or are suppressed, while resistant bacteria that were already present or were acquired can survive and multiply. This occurs in the pathogen causing the illness and in the patient’s normal flora, including organisms in the bowel and on the skin. A broad-spectrum agent therefore affects more bacteria than the one being targeted. Bacteria evade treatment through several recurring strategies: - Enzymatic inactivation: beta-lactamases can destroy beta-lactam antibiotics; extended-spectrum beta-lactamases and carbapenemases can eliminate options that would otherwise treat serious gram-negative...