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The increased rates of multiresistant pathogens are a global threat to the healthcare system. As the delivery of new antimicrobials is far from addressing all resistance challenges, new alternatives to improve the current use of antimicrobials have been increasingly studied and adopted. One of the most relevant is undoubtedly antimicrobial stewardship (AMS). Antimicrobial stewardship is increasingly used to improve adherence to guidelines and clinical outcomes, to decrease antimicrobial resistance and other collateral damage and to control costs. A recent Cochrane review investigated the effectiveness and safety of AMS and found high-certainty evidence that interventions lead to more hospital patients receiving the appropriate treatment according to antibiotic policies and moderate-certainty evidence that interventions reduce the length of hospital stay without affecting safety.(1) Several pitfalls and limitations exist that may compromise the proper conception, implementation and development of AMS for intensive care units (ICU). The purpose of this paper is to briefly address some of the main pitfalls.

What every intensivist must know about antimicrobial stewardship: its pitfalls and its challenges