Anti-Infective Stewardship and Resistance

Every antimicrobial order affects two patients: the person being treated and the microbial community exposed to the drug. An effective agent can save a life, but each exposure also selects for organisms that survive through beta-lactamases, altered drug targets, efflux pumps, porin loss, or other resistance mechanisms. Those organisms can then spread clonally or transfer resistance genes on mobile genetic elements. Stewardship is therefore not the avoidance of antibiotics; it is the deliberate use of the right drug, dose, route, and duration for a probable infection, followed by a timely decision to narrow or stop. Canada’s resistance burden continues to rise, particularly among resistant Gram-negative organisms, carbapenemase- and ESBL-producing Enterobacterales, resistant Neisseria gonorrhoeae, and the emerging pathogen Candida auris. The Pan-Canadian Action Plan on Antimicrobial Resistance organizes the national response around research and innovation, surveillance, stewardship, infection prevention and control, and leadership. In acute-care hospitals, antimicrobial stewardship is an Accreditation Canada Required Organizational Practice, not a separate federal prescribing statute. For the NP, the clinical model is sequential: identify the likely syndrome and severity, obtain useful specimens without delaying urgent...