Antimicrobial stewardship in critical care

Antimicrobial resistance (AMR) remains one of the most significant threats to global health, largely driven by inappropriate antibiotic use. This review outlines the current principles and practices of antimicrobial stewardship (AMS) in the context of critical care. We address the global burden of AMR, the development of resistance and the implementation of AMS strategies from multidisciplinary, diagnostic and pharmacokinetic perspectives. The use of rapid diagnostics, biomarkers such as procalcitonin, and the integration of electronic health records are discussed as enablers of targeted therapy and improved outcomes. Special populations, such as transplant recipients and critically ill patients with sepsis, are examined in the context of AMS, with attention to therapy optimization and resistance prevention. Challenges in implementation - especially in low-resource settings - are addressed, highlighting the need for global cooperation and infrastructure investment. Through evidence-based strategies, stewardship programs aim to enhance antimicrobial efficacy, minimize resistance development, and improve patient outcomes. This review advocates for the responsible use of antimicrobials across all care settings and emphasizes the necessity of continuous education, surveillance and adaptation in AMS policy and practice.