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We Are Guardians
As Infectious Diseases physicians, when asked about the importance of antimicrobial stewardship, many of us may share the same answers. For one, if we continue our current practices, antimicrobial resistance will lead to more deaths by the year 2050 than cancer [1]. Further, there are the risks of diarrhea, Clostridioides difficile colitis, cytopenia, hepatotoxicity, nephrotoxicity, severe drug eruption, among additional complications. Although these answers are alarming and motivate many of us in infectious diseases to appropriately prescribe antimicrobials, I find myself troubled when it does not persuade others of the importance of stewardship. For many physicians, prescribing antibiotics provides security in situations of uncertainty, rationalized by the familiar mantra, “just in case.” Because “cytopenia and hepatoxicity can be monitored with labs,” “C. difficile is treatable,” and “why worry about resistance decades later, when I have a patient to worry about now.” Shifting these mindsets is challenging, and I realized during fellowship that strategic communication, negotiation, and persuasion were just as important to my performance as an Infectious Diseases fellow as was my expertise in clinical guidelines. However, as I transitioned to the bench for my physician scientist training, I came to appreciate a better, more convincing answer for the importance of antimicrobial stewardship. An answer that I believe validates the need for our specialty and makes me look at the future of our field with nothing but optimism. It centers on the importance of microbes.