Inclusion, diversity, access, and equity in antimicrobial stewardship: where we are and where we are headed.

Abstract

This review summarizes existing data on health inequities in antimicrobial stewardship, identifies data gaps and barriers, and reflects on mitigating factors for achieving inclusion, diversity, access, and equity in antimicrobial stewardship. Studies show variable antimicrobial prescribing patterns and adverse events according to race/ethnicity, rurality, socioeconomic status, and other factors. Most studies demonstrating these inequities typically do not address their upstream drivers or interventions to mitigate them. Approaching antimicrobial stewardship through a lens of equity can allow antimicrobial stewardship programs (ASPs) opportunities to reach a wider population, and in doing so reduce health inequities. These opportunities include expanding ASPs beyond highly resourced institutions, educational outreach efforts, equity monitoring tools, incentivized equity metrics, and leadership diversification. Clinical research in this area also needs to address drivers of inequities and innovative approaches to mitigating and reducing them.