Antimicrob Steward Health Epid
What antimicrobial stewards need to know: updated guidance
Clinical Takeaway: Antimicrobial stewardship programs can use the new tiered framework to identify gaps in current capabilities and plan toward more advanced functions.
Antimicrobial stewardship has become central to limiting antibiotic resistance, C. difficile infection, and other consequences of suboptimal antimicrobial use. But expanded accreditation standards, new reporting requirements, and the spread of stewardship beyond acute care have reshaped what leading a program actually requires.
The central update is a tiered skills framework. Competencies are now sorted into basic (establishing structure, meeting CDC Core Elements and Joint Commission standards), intermediate (adding EHR interventions, clinical decision support, and diagnostic stewardship), and advanced (dashboards, transitions of care, research, multisite collaboration). The tiers apply across acute care, outpatient, and long-term care settings.
The guidance also broadens who can lead. While CDC endorses co-leadership by an infectious diseases–trained physician and pharmacist, the societies acknowledge that model is not always practical and explicitly support non–infectious diseases–trained clinicians and infection preventionists who lead effective programs.
Beyond clinical knowledge, the document emphasizes quality improvement, change management, communication, data analytics, and partnerships with infection prevention, microbiology, IT, and institutional leadership as core skills, not optional add-ons. A supplementary gap-assessment tool helps programs map current capabilities against desired ones.
Staffing models and requirements as well as reporting structure are deferred to future society publications.
"Knowledge and skills described in this document intend to help 'raise the bar' for ASPs," the authors write, distinguishing programs that meet baseline requirements from those that achieve broader patient-safety goals.
Source: Holubar M. Antimicrob Steward Healthc Epidemiol. 2026 May 11. Guidance for the Knowledge and Skills Required for Antimicrobial Stewardship Leaders