It’s not just infectious organisms that are evolving—antimicrobial stewardship is, too. Three emerging developments in antimicrobial stewardship warrant special attention over the next few years:
Identification of best practices—Because the importance of antimicrobial stewardship has only gained widespread recognition in the last decade, research into the most effective strategies for improving antibiotic prescription practices and outcomes continues to refine our understanding of best practices in this area. The Centers for Disease Control and Prevention note that the growing number of facilities implementing antimicrobial stewardship programs enables researchers to better characterize the impact of various interventions on resistance. Going forward, research facilitated by the CDC’s National Healthcare Safety Network (NHSN) will help identify which policies produce the greatest benefit in terms of slowing the emergence of resistant organisms and extending the life of existing therapies.1
Laboratory testing—Some antimicrobial stewardship (AMS) programs have already incorporated rapid diagnostic tests which can positively identify infectious agents in a matter of hours rather than days, dramatically reducing delays in implementation of effective therapies. Use of fluorescence in situ hybridization using peptide nucleic acid probes (PNA FISH®), for instance, has been shown to identify Enterococcus faecium 2.3 days earlier than conventional microbiological methods and reduces the time to initiation of effective therapy by 1.8 days in research conducted at the University of Maryland.2 Other research indicates that PNA FISH can contribute to decreased hospital costs and shorter lengths of stay for patients with Staphylococcus aureus and coagulase-negative staphylococci.3 Procalcitonin tests can quickly determine whether a patient has systemic bacterial infection. Matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometric analysis detects the presence of carbapenemases in three hours, enabling nearly immediate aggressive treatment of resistant bacteria.
IT integration—As hospitals and other providers have adopted electronic health records, information on antibiotic use has become easier to assemble and compare across prescribers, units and facilities. Now, hospitals can prospectively audit antibiotic prescriptions to ensure good bug/drug matches as well as compliance with other policies and procedures. At the same time, they can monitor admissions, laboratory and microbiology data feeds in real time to identify patients who need to begin antimicrobial therapy and those who are on ineffective treatments for their specific infections. As more hospitals implement electronic surveillance software, the potential impact of integrated IT support for AMS programs will become more fully understood.
 CDC. Core Elements of Hospital Antibiotic Stewardship Program. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
2 Forrest GN, Roghmann MC, Toombs LS, Johnson JK, Weekes E, Lincalis DP, Venezia RA. Peptide nucleic acid fluorescent in situ hybridization for hospital-acquired enterococcal bacteremia: delivering earlier effective antimicrobial therapy. Antimicrob Agents Chemother. 2008 Oct;52(10):3558-63.
3 Holtzman C, Whitney D, Barlam T, Miller NS. Assessment of impact of peptide nucleic acid fluorescence in situ hybridization for rapid identification of coagulase-negative staphylococci in the absence of antimicrobial stewardship intervention. Journal of clinical microbiology. Apr 2011;49(4):1581-1582.