Antimicrobial stewardship failure: time for a new model

There are now 10 years of national antimicrobial consumption data in Ireland. Despite the creation of an ‘antimicrobial stewardship and infection control industrial complex’ over this period, the data demonstrate a 16% increase in consumption nationally. Given the ongoing challenges with carbapenemase-producing Enterobacterales and Clostridioides difficile within the acute hospital system, the data point to the ineffectiveness of the national antimicrobial stewardship programme/model. A different model of antimicrobial stewardship is therefore needed. This new model is one based around the collection and dissemination of physician-specific consumption, together with greater education of clinicians in the management of infections. By shining a light on individual clinician antibiotic prescribing, outlier identification, along with peer to peer (or clinician to clinician) pressure, can be brought to bear on the problem and shift the emphasis from the current ‘policing’ oversight, to self-regulation instead.