Hospitalists as Integral Stakeholders in Antimicrobial Stewardship

Abstract

The purpose of this review is to discuss the role of the hospitalist in antimicrobial stewardship programs (ASPs), to offer antimicrobial stewardship strategies that hospitalists can implement, to discuss opportunities for hospitalists to serve as educators on stewardship practices, and to offer resources for hospitalists to gain further training in antimicrobial stewardship. Antimicrobial stewardship is vital to combat antibiotic resistance, and effective stewardship requires a multidisciplinary approach. Antimicrobial stewardship programs have typically included infectious disease specialists and pharmacists and, traditionally, have been limited to larger academic centers. With the 2017 Joint Commission standards requiring ASPs in all hospitals, there is increasing need for involvement of additional bedside stewards. Hospitalists care for a majority of inpatients allowing them to collaborate with traditional ASPs or lead new stewardship efforts. Hospitalists should engage in current antimicrobial stewardship programs and can also serve as leaders in program development in resource-limited settings. Methods of engagement include assisting with recruitment of multidisciplinary personnel, participating in current stewardship committees and protocol development, and leading educational efforts on antimicrobial stewardship strategies. Antimicrobial stewardship metrics such as length of stay, readmission rates, and mortality are parallel to metrics used by hospital medicine groups and unifying efforts will, ideally, result in improved patient outcomes as well as reduction in antibiotic resistance.