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1REFERENCES
 Canada A. Required Organizational Practices Handbook 2017. Ottawa, Canada: Accreditation Canada; 2016.

2 Schuts EC, Hulscher ME, Mouton JW, Verduin CM, Stuart JW, Overdiek HW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(7):847-56.

3 Valiquette L, Cossette B, Garant MP, Diab H, and J Pepin. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis. 2007;45 Suppl 2:S112-21.

4 Public Health Agency of Canada. Canadian Antimicrobial Resistance Surveillance System--Report 2016. Ottawa, Canada; 2016.

5Mitchell BG, and A Gardner. Mortality and Clostridium difficile infection: a review. Antimicrobial resistance and infection control. 2012;1(1):20.

6 Miller MA, Hyland M, Ofner-Agostini M, Gourdeau M, and M Ishak. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol. 2002;23(3):137-40.

7 Bai AD, Showler A, Burry L, Steinberg M, Ricciuto DR, Fernandes T, et al. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study. Clin Infect Dis. 2015;60(10):1451-61.

8 Tzouvelekis LS, Markogiannakis A, Piperaki E, Souli M, and GL Daikos. Treating infections caused by carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect. 2014;20(9):862-72.

9 Leal JR, Heitman SJ, Conly JM, Henderson EA, and BJ Manns. Cost-Effectiveness Analysis of the Use of Probiotics for the Prevention of Clostridium difficile-Associated Diarrhea in a Provincial Healthcare System. Infect Control Hosp Epidemiol. 2016;37(9):1079-86.

10 Thampi N, Showler A, Burry L, Bai AD, Steinberg M, Ricciuto DR, et al. Multicenter study of health care cost of patients admitted to hospital with Staphylococcus aureus bacteremia: Impact of length of stay and intensity of care. Am J Infect Control. 2015;43(7):739-44.

11 Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-9.

12 CDC. Core elements of hospital antibiotic stewardship programs. In: Services UDoHaH, editor. Atlanta, GA: The National Center for Emerging and Zoonotic Infectious Diseases; 2014.

13 Le Coz, P, Carlet, J, Roblot F, and C Pulcini. Ressources humaines nécessaires aux équipes multidisciplinaires en antibiothérapie dans les établissements de santé français. Medecine et Maladies Infectieuses 2016; 46(4): 200-206.

14 Haley RW, Morgan WM, Culver DH, White JW, Emori TG, Mosser J, et al. Update from the SENIC project. Hospital infection control: recent progress and opportunities under prospective payment. Am J Infect Control. 1985;13(3):97-108.

15 O'Boyle C, Jackson M, and SJ Henly. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control. 2002;30(6):321-33.

16 Santé et Services sociaux Québec. Comité d'examen sur la prévention et le contrôle des infections nosocomiales. D'abord ne pas nuire... les infections nosocomiales au Québec, un problème majeur de santé, une priorité. Québec City, QC2002.

17 Spellberg B, Srinivasan A, and HF Chambers. New Societal Approaches to Empowering Antibiotic Stewardship. JAMA. 2016;315(12):1229-30.

18 Armstrong, GL., LA Conn and RW Pinner. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999;281(1): 61-66.

19 Novotny J, and M Novotny. Adverse drug reactions to antibiotics and major antibiotic drug interactions. Gen. Physiol. Biophys. 1999;18:126–139.

20 Zed PJ, Abu-Laban RB, Balen RM et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ. 2008;178(12):1563-1569.

21 Hecker MT, Aron DC, Patel NP, Lehmann MK and CJ Donskey. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med. 2003;163(8): 972-978.

22 Dellit, TH et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2): 159-177.

23 Hooton TM, et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med. 2000;343(14): 992-997.

24 Lin, L, K Fajardo and U. S. P. S. T. Force. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008;149(1): W20-24.

25 Silver SA, Baillie L and AE Simor. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals? Can J Infect Dis Med Microbiol. 2009;20(4): 107-111.

26 Rice, LB. The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and clostridium difficile. Clin Infect Dis. 2008;6(4): 491-496.

27 Sandberg, T et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet 2012; 380(9840): 484-490.

28 Sawyer, RG et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 2015; 372(21): 1996-2005.

29 Chastre, J, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19): 2588-2598.

30 Rafailidis, PI, AI Pitsounis and ME Falagas. Meta-analyses on the optimization of the duration of antimicrobial treatment for various infections. Infect Dis Clin North Am. 2009;23(2): 269-276.

31 Kim JH, and HA Gallis. Observations on Spiraling Empiricism: Its Causes, Allure, and Perils with Particular Reference to Antibiotic Therapy. Am J Med. 1989;87:201-206.

32 Charani E, Castro-Sanchez E, Sevdalis N et al. Understanding the determinants of antimicrobial prescribing within hospitals: The role of prescribing etiquette. Clinical Infectious Diseases 2013;57(2):188–96.

33 Rahal, JJ, et al. Class Restriction of Cephalosporin Use to Control Total Cephalosporin Resistance in Nosocomial Klebsiella. JAMA. 1998;280(14): 1233-123.

34 Burke, JP. Antibiotic Resistance—Squeezing the Balloon? JAMA. 1998;280(14): 1270-1271.

35 Meyer, E, Gastmeier E, Deja M and F Schwab. Antibiotic consumption and resistance: data from Europe and Germany. Int J Med Microbiol. 2013;303(6-7): 388-395.

36 MacDougall, CJ, Powell P, Johnson CL, Edmond MB and RE Polk. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis. 2005;41(4): 435-440.

37 Fleming A, Chain E, et al. Penicillin and streptomycin. Lancet. 1947;2(6472):397.


38 McGowan JE, Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983;5(6):1033-48.

39 Årdal C, Outterson K, Hoffman SJ, Ghafur A, Sharland M, Ranganathan N,


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