When it comes to stewardship, it’s time to get with the programmers

Reducing antimicrobial use is believed to be a critical intervention in an era of impending catastrophic drug resistance, with little promise in the antimicrobial pipeline (1,2). Up to one-half of human antimicrobial use is believed to be inappropriate in terms of indication, choice of agent or duration (3). After years of research, it is clear that the most important determinant of resistance development is the use of an antimicrobial (4,5). In an effort to counteract overuse, Accreditation Canada now mandates, in its Required Organizational Practices, the existence of a multidisciplinary antimicrobial steward-ship program (ASP) at most inpatient health care facilities, including long-term care facilities providing ‘complex continuing care’ (6). Successful ASPs have demonstrated benefits including reduced drug resistance, fewer Clostridium difficile infections and reduced anti-microbial-related toxicity, with no demonstrated adverse clinical outcomes .