The Current State of Antimicrobial Stewardship: Challenges, Successes, and Future Directions

  • Jennifer EmbergerEmail author
  • Dan Tassone
  • Michael P. Stevens
  • J. Daniel Markley
Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Healthcare Associated Infections


Purpose of Review

The aim of this study is to examine the current state of the field of antimicrobial stewardship (AS) by highlighting key challenges and successes, as well as exciting future directions.

Recent Findings

AS mandates from the Centers for Medicare and Medicaid (CMS) and the Joint Commission (TJC) will stimulate increased compliance with current AS standards, but overall compliance is currently poor. Key challenges to progress in the field of AS include insufficient workforce and monetary resources, poorly defined AS metrics, and much needed expansion beyond the inpatient hospital setting. Despite these challenges, massive progress has been made in the last two and a half decades since the field of AS emerged. AS metrics are rapidly evolving and transforming the way antimicrobial stewardship programs (ASPs) measure success. Rapid diagnostics and diagnostic test stewardship are proving to be extremely effective when coupled with an ASP. Telehealth may improve access to ASP expertise in resource poor settings, and the role of bedside nurses as ASP team members has the potential to greatly augment ASP efforts. Allergy testing as an ASP strategy remains largely underutilized.


ASPs have made significant gains in the battle against antimicrobial resistance (AR), but considerable advancement is still needed. Awareness of current challenges is critical to ensure progress in the field. The field of AS is expanding and transforming rapidly through integration, technology, and improved processes.


Antimicrobial stewardship Antimicrobial utilization Antimicrobial stewardship metrics Diagnostic test stewardship Rapid diagnostics Telemedicine 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights Statement

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jennifer Emberger
    • 1
    Email author
  • Dan Tassone
    • 2
  • Michael P. Stevens
    • 3
  • J. Daniel Markley
    • 4
  1. 1.Virginia Commonwealth University Medical CenterRichmondUSA
  2. 2.Hunter Holmes McGuire Veterans Affairs Medical CenterVirginia Commonwealth University School of PharmacyRichmondUSA
  3. 3.Department of Internal Medicine, Division of Infectious DiseasesVirginia Commonwealth University Medical CenterRichmondUSA
  4. 4.Department of Internal Medicine, Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical CenterVirginia Commonwealth University Medical CenterRichmondUSA

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