Good antimicrobial stewardship in the hospital: fitting, but flagrantly flagging.

There are two general approaches to preventing or reversing antimicrobial resistance in the hospital setting. Prevention of transmission of resistant organisms from patient to patient is the traditional infection control approach that, if practiced perfectly, would resolve the problem of nosocomial infection due to resistant .organisms. It is the stuff of which all good hospital epidemiologists and infection control professionals are made. The second approach originates from the observation that the emergence of antimicrobial resistance is related to the use of antimicrobials. This approach is built on the premise that antimicrobial use (which is highly beneficial in the treatment of patients) is less than optimal and that, by improving (or reducing) use, there will occur a corresponding prevention or decline of antibiotic resistance. Both approaches were advocated in the "Guidelines for die Prevention of Antimicrobial Resistance in Hospitals" issued jointly in 1997 by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).