9 This review serves as a primer on antimicrobial stewardship tailored for emergency care providers. However, policy changes such as the Joint Commission’s antibiotic stewardship accreditation standard (enacted January 1, 2017) and inclusion of stewardship quality metrics in the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System 7, 8 will increasingly require ED providers to engage in these efforts. 6 The emergency department (ED) has traditionally been underrepresented as a focus for antimicrobial stewardship efforts. There is a substantial body of literature supporting the ability of hospital antimicrobial stewardship programs (ASPs) to reduce costs while also exerting a positive impact on clinical outcomes. 3– 5 Antimicrobial stewardship refers to efforts aimed at optimizing the use of anti-infective medications. To address this public health crisis, tremendous efforts have begun to curb the widespread inappropriate use of antimicrobials in both human health and agriculture. A substantial increase in global rates of infections related to resistant pathogens, in combination with limited new antimicrobial agents in development, has raised concerns of an impending “post-antibiotic era” with potential catastrophic consequences for human health. Antimicrobials are critically important medications that affect not only the patient receiving them but also the surrounding community. 1 Pathogen resistance develops in response to selective pressure associated with all antibiotic prescribing but is accelerated by inappropriate use. Antimicrobials are unique among all classes of therapeutics in that they decrease in effectiveness over time and in direct relation to the frequency of use.
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