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All Hands on Deck: Antimicrobial Stewardship Programs From a Laboratorian’s Perspective

Contributed Commentary by Amanda Suchanek, Ph.D., bioMérieux 

November 11, 2022 | After nearly three years of dealing with COVID-19, the last thing anyone wants to hear is news of another looming global health crisis. Unlike COVID-19, this one has been lurking for some time. Scientists, doctors, nurses, pharmacists, and patients have a unique ability and responsibility to address the problem before it gets out of control. The crisis I am referring to is antimicrobial resistance (AMR). 

AMR is more than simply the development of antibiotic resistance (AR) in bacteria. It is a complex phenomenon that includes the full spectrum of microbes—bacteria, viruses, protozoa, yeasts, and fungi—all of which can become resistant to treatment with antimicrobials. In many cases, they already have.  

Dr. Rodney Rohde, chair of clinical laboratory medicine at Texas State University, said it best when he described the development of AMR and AR as a “slow-burning global emergency.” As common pathogens become increasingly resistant to current lines of treatment, we will see more and more lives lost to infections that were once easily treatable.  

In clinics and hospitals across the US and worldwide, initiatives to combat AMR are underway (Open Forum Infectious Diseases, DOI: 10.1093/ofid/ofab422 and Epidemiologic Reviews, DOI: 10.1093/epirev/mxz010). One such initiative, antimicrobial stewardship (AMS), is presently our best hope. Unfortunately, while many AMS programs include infectious disease and pharmacology experts, clinical laboratorians are often left off the attendee roll.  

To fully address the various components of the AMR crisis, AMS programs must be multidisciplinary (Antibiotics, DOI: 10.3390/antibiotics11020250) and include collaboration between physicians, laboratorians, microbiologists, public health officials, hospital administrators, pharmacists, nurses, and the patients themselves. If COVID-19 has taught us anything, it is that clear, concise communication of the science has been lacking in every area. During the height of the pandemic, messaging was often contradictory or outright incorrect, and it was not just the general public that was affected.  

I recently watched a live webcast sponsored by the Pew Charitable Trusts titled “Antibiotic Resistance: A Looming Public Health Crisis” from May 2022. All the panelists were great, but it was incredibly disappointing that no microbiology expert was included in the discussion. In fact, the word “laboratory” was never used in the entire 90-minute discussion. Yet almost everyone pointed out that antimicrobial resistance and stewardship programs require a community-wide level of cooperation to succeed.  

Unless one purposefully seeks information about how microbiologists can use their expertise to aid in antimicrobial stewardship programs, it may not always be evident. I am not saying this to downplay or negate the critical roles that physicians, pharmacists, nurses, hospital administrators, or even patients play. Instead, I say this because the focus should be on cross-discipline collaboration that makes a concerted effort to include all disciplines relevant to the issue. 

Patients, or parents with minor children, also have a crucial role to play. For example, my youngest nephew is about 18 months old and suffers from chronic ear infections. Like any good mother, if my sister sees her son pulling on his ear, she will take him to the pediatrician and pick up a prescription for an antibiotic on the way home. The disheartening part is that his tiny body has already been exposed to four different antibiotics over the last six months.  

This scenario highlights the vital role that patients play because my sister is doing everything right based on her current knowledge. However, questioning the risks and benefits of keeping a child on one antibiotic versus switching to another is difficult for parents when they don’t fully understand what drives their pediatrician to make these decisions.  

What if the ear infection is not bacterial? How does a parent or patient know to question that? Tests exist in the laboratory to guide answers to these questions, but again, if we, the scientists, are not communicating this to patients, what good are they? I realize that some tests are better than others, and some are difficult to run—especially with pediatric ear infections—but my point here is that communication is key. We must work together for better outcomes. 

The importance of antimicrobial stewardship cannot be understated. Laboratorians and microbiology experts must be included in every program along with physicians, pharmacists, hospitalists, and patients to ensure the proper and appropriate use of antimicrobials on a case-by-case basis. AMR is not a crisis waiting to happen; it is already here. What matters now is how we work together to mitigate the worst potential consequences. 

Dr. Amanda Suchanek is a medical science liaison at bioMérieux. She began her career in the lab in 2002 as a work-study student at the University of Washington. After earning her Bachelor of Science in Biology, Suchanek worked as a clinical research technician studying blood cancers at Fred Hutchinson Cancer Research Center. In 2015, she earned her Ph.D. in Biochemistry and Molecular Biology at West Virginia University. Upon completing her Ph.D., she was offered a postdoctoral fellowship in biochemical nutrition at the University of North Carolina at Chapel Hill. She can be reached at