Antimicrobial stewardship

Also known as: antibiotic resistance · antibiotic stewardship

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United StatesIDSA/CDC

Current

Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

IDSA / Society for Healthcare Epidemiology of America (SHEA) · 2016

Joint IDSA/SHEA guidance on how to set up, run and measure antibiotic stewardship interventions in inpatient settings, including long-term care.

The guideline covers intervention types such as preauthorisation and prospective review, use of diagnostics, education, and program measurement. source
It states that interventions should be tailored to local prescribing behaviour, barriers and resources rather than applied uniformly. source

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EuropeESCMID/ECDC

Current

ESCMID guidelines for antimicrobial stewardship in emergency departments

ESCMID Study Group for Antimicrobial Stewardship (ESGAP) · 2024

ESCMID's current European stewardship guideline, focused on antimicrobial prescribing in emergency departments, developed by its Study Group for Antimicrobial Stewardship and published in Clinical Microbiology and Infection in 2024.

It examines whether biomarkers, rapid pathogen tests and blood cultures in common infectious syndromes improve prescribing and outcomes. source
The guideline stresses adapting implementation strategies to the facilitators and barriers of each individual emergency department. source

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US vs EU key differences

Scope differs fundamentally: the IDSA/SHEA document is a whole-institution blueprint for building a hospital antibiotic stewardship programme, while the ESCMID guidance is narrowly scoped to stewardship practice in emergency departments. source
Version currency differs: the US programme-implementation guideline dates to 2016, whereas the ESCMID emergency-department guideline was published in Clinical Microbiology and Infection in November 2024. source
The core US intervention is structural — a strong recommendation for preauthorisation and/or prospective audit with feedback as an essential component of any stewardship programme. source
The ESCMID guideline instead answers point-of-care clinical questions: whether biomarkers or rapid pathogen tests improve prescribing, whether blood cultures in common infectious syndromes change outcomes, and the role of watchful waiting and delayed prescribing. source

What changed recently

US2007 → 20162016-04-13
The 2016 IDSA/SHEA guidelines replaced the broad 2007 blueprint for what a stewardship programme should look like with GRADE-rated recommendations for specific interventions, notably preauthorisation and/or prospective audit with feedback as core activities. They also added syndrome-specific strategies, antibiotic time-outs, allergy delabelling and use of rapid diagnostics and procalcitonin to shorten therapy.
source ↗curation confidence 90%

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