Antimicrobial stewardship has traditionally focused on optimizing antibiotic use to improve patient care, but growing attention to environmental sustainability is expanding how stewardship teams think about resource use. From the plastic waste generated during medication preparation and administration to opportunities to incorporate environmental considerations into antibiotic selection, stewardship offers a natural opportunity to address both clinical and environmental priorities.

Dr. Pam Lee and Dr. Gary Fong developed EcoRxChoice.com, a free calculator designed to integrate environmental metrics into antimicrobial stewardship. The calculator estimates the amount of plastic waste associated with different antimicrobial regimens by accounting for materials used in medication preparation and administration. In their paper published in ASHE, "EcoRxChoice.com— an SIDP-funded calculator integrating environmental metrics with antimicrobial stewardship," the authors describe how they developed the calculator, including physically weighing items ranging from IV bags and tubing to needle hubs and medication packaging.

In this episode, Dr. Lee and Dr. Fong discuss the origins of EcoRxChoice.com, the surprising amount of plastic waste generated through routine medication preparation, and how environmental impact can be incorporated into antimicrobial decision-making. They also explore the role of IV-to-oral conversion, the challenges of integrating sustainability into pharmacy and medical education and electronic medical records, and future opportunities to expand the calculator to other areas of stewardship and infection prevention.

Links and Recommendations:

• EcoRxChoice.com— an SIDP-funded calculator integrating environmental metrics with antimicrobial stewardship: https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/ecorxchoicecom-an-sidpfunded-calculator-integrating-environmental-metrics-with-antimicrobial-stewardship/83C55C51C9C446C4728FF1980CD2EC14
• https://ecorxchoice.com/?page=plasticWasteCalculator
• Development of a Novel Carbon Emissions Estimation Tool for Disposable Waste Associated With Antimicrobial Packaging, Preparation, and Administration in the Hospital Setting: https://academic.oup.com/ofid/article/12/10/ofaf308/8183152

Antimicrobial stewardship has evolved dramatically over the past decade, driven by expanding regulatory requirements, broader implementation across healthcare settings, advances in diagnostic stewardship, and growing opportunities to leverage technology. As stewardship programs continue to mature, leaders must develop skills in leadership, change management, collaboration, quality improvement, and strategic planning.

Dr. Sarah Cosgrove, Dr. Whitney Buckel, and a multidisciplinary group of experts from the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) developed an updated guidance document outlining the knowledge and skills required for antimicrobial stewardship leaders. Building on the original 2014 publication, the guidance provides a framework for stewardship programs across acute care, ambulatory care, and long-term care settings, with competencies spanning basic, intermediate, and advanced levels.

In this episode, the authors discuss how antimicrobial stewardship has changed since the original guidance was published, the growing role of diagnostic stewardship and collaboration, and the opportunities and challenges of artificial intelligence. They also share practical advice for using the guidance to strengthen stewardship programs, build future leaders, and prepare for the next decade of antimicrobial stewardship.

Links and Recommendations:

• Guidance for the Knowledge and Skills required for Antimicrobial Stewardship Leaders: https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/guidance-for-the-knowledge-and-skills-required-for-antimicrobial-stewardship-leaders-an-update-from-the-society-for-healthcare-epidemiology-of-america-infectious-diseases-society-of-america-pediatric-infectious-diseases-society-and-the-society-of-infectious-diseases-pharmacists/3B710B07D042BDF0A2B3D2090E1B9665

Candida auris has emerged as a major healthcare-associated pathogen due to its multidrug resistance, environmental persistence, and ability to spread between patients and healthcare facilities. Until now, infection prevention guidance has focused almost entirely on adults.

Dr. Thomas Murray, Dr. Natalie Neu, and an international multidisciplinary panel developed the first comprehensive pediatric-specific infection prevention and control recommendations for Candida auris using a rigorous Delphi consensus process. The guidance addresses children's hospitals, outpatient clinics, long-term pediatric care settings, and other congregate environments, balancing transmission prevention with family-centered care.

The recommendations cover screening, Contact Precautions, room placement, caregiver involvement, breastfeeding, shared play spaces, environmental cleaning, equipment management, and coordination with public health agencies, while also providing expert consensus where evidence is limited.

In this episode, the authors discuss why pediatric-specific guidance was needed, how the recommendations were developed, and what healthcare facilities can do to prepare for the continued emergence of Candida auris.

Links and Recommendations:

• Infection prevention and control of Candida auris in pediatric settings: https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/infection-prevention-and-control-of-candida-auris-in-pediatric-settings/D1012137F51BF268BC89FE5DBCC1DA8A