Should infection control teams enforce an antimicrobial stewardship program for all clinicians?

To the Editor—The Japan Council for Quality Health Care assesses Japanese hospitals according to various criteria and makes the results available on the Internet. One of the most significant criteria is this: "Are specific antimicrobial agents (carbapenems, vancomycin, etc.) administered under a proper stewardship program, such as a permission and notification system?" Because of this item, many Japanese hospitals have forced all clinicians to work within the terms of the antimicrobial stewardship program without sufficiently considering the precise meaning of the criterion. Because "etc." and "proper" are not clearly defined, a variety of types of antimicrobial stewardship can be found in Japan. The typical program applies to all clinicians and checks prescriptions or requires permission to use specific agents. Some Japanese studies have reported that the antimicrobial stewardship program is as useful in Japan as in Western countries. However, the adverse effects of the stewardship program have not yet been described in detail or discussed thoroughly. I present here some questions related to a type of stewardship program that can apply to all clinicians.