Another challenge to implementing antimicrobial stewardship in the ICU deals with the confidence intensivists have in the clinical judgement of the stewardship physician.
Managers of health services may also consider options for building workforce capacity to manage chronic and complex illness, where roles can be configured within non-admitted services that may not necessarily be dependent on physician stewardship but where nurses and allied health professionals as non-physician providers play a central role.
When dealing with bacteria that do not respond to treatment, the major tactic utilized is antibiotic stewardship, whereby the physician switches the patient to a new class of antibiotics with different underlying mechanisms of action, and thus mechanisms of resistance.
Antimicrobial stewardship programs involving pharmacists, physicians and other healthcare providers optimize antibiotic selection, dose, and duration to increase efficacy in targeting causative pathogens and allow the best clinical outcome.
Improvements in cost and efficiency of existing stewardship programs, and improved physician knowledge regarding treatment and pathogen prediction were also noted [ 27- 29].
2. The responsibility for stewardship and teaching of resident physicians requires special oversight of residents' patients who receive controlled substances.
Many hospitals put the drugs "on reserve," but an apparent cure-all was too tempting for some physicians, and the tight stewardship slowly broke down.
However, it would be better to have structured antimicrobial stewardship training programs for trainee ID physicians and to have adequate succession/contingency planning.
Both ID physicians (not involved in antimicrobial stewardship) and ASPs should ideally support the concept of antimicrobial stewardship and appropriate prescription of antimicrobial agents [ 1, 7].
Concerning department and hospital characteristics, including available stewardship elements, the presence of an ID physician was positively associated with prescribing empirical therapy in accordance with the national guideline.
