Bacterial resistance to antibiotics is growing up as a shadow in the community and hospital setting, with a significant impact on mortality and morbidity.
Several efforts have been made in order to control the spread of multi drug resistant (MDR) bacteria such as hand hygiene, decolonisation or active surveillance culture and contact precautions. Although antimicrobial therapy is frequently prescribed, there is a lot of work to be done for a wise use, since each time an antibiotic is administered we exert a selective pressure not only on the bacterial flora of the human body but also on the hospital environment. The MDR microorganisms include mostly Gram-negative, but also methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).
However, there is a few light shed by new antibiotics which unfortunately does not cover the increasing prevalence of antibiotic resistance. Only a correct antimicrobial stewardship program, which involves a multifaceted approach with the aim of reducing the emergence of resistance, improving clinical outcomes and control costs by increasing appropriate antimicrobial use is helpful. This paper highlights the main issues of a stewardship program by clinical, epidemiological, microbiological and pharmacological viewpoints.

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Key words: antibiotics, antimicrobial stewardship, MDR, gram negative, resistance