The Future of Antimicrobial Stewardship Starts Beyond the Hospital

Tho Pham, PharmD, BCIDP, emphasized that antimicrobial stewardship is undergoing an important shift from a hospital-focused practice to a broader, community-based public health effort. Reflecting on themes emerging at the MAD-ID/SIDP Joint Meeting, Pham highlighted growing attention to antifungal stewardship and resistance, particularly as multidrug-resistant Candida species and invasive mold infections become more prevalent. She also pointed to rapid diagnostics and acute care stewardship innovations as areas of strong interest, noting the importance of translating successful hospital-based interventions into outpatient and long-term care settings, which she described as the “final frontiers” for comprehensive stewardship programs.

According to Pham, stewardship priorities at both the state and national levels increasingly focus on equity, scalability, and resource accessibility. She explained that smaller outpatient clinics, long-term care facilities, and rural health systems often face staffing shortages and competing priorities that make implementation of stewardship initiatives more challenging than in large academic medical centers. In Arizona, efforts are focused on expanding stewardship support to underserved settings through toolkits, pharmacist-led guidance, and public health infrastructure designed to ensure patients in rural communities receive the same level of expertise as those treated in major metropolitan hospitals. Pham also emphasized the growing importance of a “One Health” perspective, recognizing antimicrobial stewardship as a collaborative public health effort that extends beyond bedside care.

Pham underscored the evolving leadership role of pharmacists in antimicrobial stewardship, arguing that pharmacists are moving from supportive contributors to essential co-leaders across care settings. She highlighted pharmacist-led efforts such as penicillin allergy delabeling, vaccine advocacy, and patient education as key strategies for reducing inappropriate antibiotic use and slowing antimicrobial resistance. For pharmacists attending MAD-ID, Pham encouraged an open-minded approach to stewardship, urging clinicians to adapt hospital-based best practices for outpatient and long-term care environments. Ultimately, she emphasized that pharmacists are uniquely positioned not only to optimize medication use, but also to shape public health outcomes by preserving the effectiveness of antibiotics for future generations.