Antimicrobial Stewardship

Every antimicrobial exposure creates selection pressure: susceptible organisms are suppressed, while resistant organisms and disrupted commensal flora may persist. The result can be treatment-limiting resistance, Clostridioides difficile infection, acute kidney injury, hypersensitivity, or other drug toxicity. Stewardship therefore asks whether an antimicrobial is indicated, then whether its spectrum, dose, route, and duration remain justified as the patient's data change. Stewardship is not withholding treatment from a patient with a dangerous infection. Septic shock, neutropenic fever, suspected bacterial meningitis, necrotizing soft-tissue infection, and rapidly progressing infection with haemodynamic instability require immediate broad empiric therapy after cultures are obtained only if doing so does not delay treatment. Once the patient is stabilized and microbiology is available, the same stewardship principles require narrowing or stopping therapy when appropriate. For Canadian nurse practitioners, this reasoning operates within provincial or territorial requirements, local formulary policy, and the organization’s antimicrobial stewardship program. Accreditation Canada has treated an antimicrobial stewardship program as a Required Organizational Practice for inpatient acute care; the Canadian lever is accreditation rather than a federal statutory hospital mandate. At the bedside, the practical...