“Stewardship” is using resources wisely. The term, “antibiotic stewardship is generally thought to have been coined in print in 1996”. Antibiotic stewardship is very specifically related to antibiotics, but sustainability takes a broader view and examines all resources. You can think of these in time resources, waste generation, and financial resources among other things. In general, when you expand your vision of savings of work in infectious diseases from just antimicrobial stewardship to resource stewardship, you will see that your work is much more impactful. 

Antimicrobial waste arises from unused doses, overly long prescriptions, and excess stock or EMR related waste. While difficult to quantify precisely, studies suggest a significant fraction of antimicrobials dispensed in hospitals are not fully consumed. This matters because drug manufacturing and disposal are resource-intensive, contributing to greenhouse gas emissions and pharmaceutical pollution in waterways. Reducing waste therefore improves both financial stewardship and environmental sustainability. Multiple pediatric hospitals have reported thousands of doses of antimicrobials wasted every year. Disposal methods such as incineration and autoclaving contribute to greenhouse gas emissions, while pharmaceutical residues enter wastewater, contaminating ecosystems and accelerating resistance. This makes stewardship an environmental as well as a clinical imperative.

Simple interventions have a dual benefit for patients and the planet. Switching from intravenous to oral antibiotics when clinically appropriate reduces plastics and energy required for IV delivery. Optimizing treatment durations avoids unnecessary doses while lowering resistance pressure. Using weight-based dosing ensures drugs are tailored, minimizing leftover product. Together, these actions reduce waste, improve outcomes, and strengthen system resilience.

Some data exists  to help us quantify this! This is considered a “gate to grave” analysis. Take a look at the assumptions made! Just to dispose of a typical endotracheal tube culture, which often is of dubious clinical significance, is the equivalent to driving 0.6 mile in a gasoline-powered vehicle.

There have been initiatives examining the clinical utility of rapid respiratory viral panels such as this article. As of June, 2025, we haven’t seen the environmental costs measured. This is a knowledge gap. 

Decreasing unnecessary testing in any of these areas would decrease solid waste and saves time for healthcare workers. This is what we suggest. 

• Endotracheal cultures sent per 1000 vent days
• Repeat rapid gastrointestinal PCR within 2 weeks of a prior assay and overall use
• Group A streptococcal tests performed for those under 3 and in conjunction with a rapid respiratory viral panel. 
• Blood cultures per 1000 patient days or encounters

Urine cultures sent per 1000 patient days or encounters and number of urine cultures performed in patients without pyuria

• Procalcitonin test performed per 1000 patient days. 
• C. Diff testing testing less than one year of age and overall tests sent 

Other tests: 

Best practices in laboratory medicine. This is the choosing wisely site in Canada. https://choosingwiselycanada.org/recommendation/medical-laboratory-science/.