Antimicrobial stewardship programs are well established in many hospitals, but some prescribing decisions occur far from inpatient wards. At IDWeek 2026, “Off the Beaten Path: Stewardship in Nontraditional Settings,” Saturday, Oct. 24, at 1:45 p.m. ET, will examine how stewardship principles can be adapted to settings ranging from retail clinics to ambulatory surgery centers and rural health care systems.
The session will be moderated by Gregory Schrank, MD, MPH, assistant professor of medicine at the University of Maryland in Baltimore, and Sophie Katz, MD, MPH, associate professor of pediatric infectious diseases at Vanderbilt University Medical Center.
Speakers will include Milner Staub, MD, MPH, assistant professor of medicine at Vanderbilt University Medical Center; Angela Vassallo, MPH, MS, CIC, FAPIC, epidemiologist, consultant and founder of The Angel Squad Project; and Jacob Kilgore, MD, MPH, associate professor in the Department of Pediatrics in the Division of Pediatric Infectious Diseases at Marshall Health Network in Huntington, West Virginia.
The presentations will highlight the rapid expansion of health care delivery models that have largely developed outside the traditional stewardship framework and implementing stewardship in resource-limited rural settings.
Growth in Direct-to-Consumer Space
In “Antibiotics on Aisle 5: What About Retail Clinics and Direct-to-Consumer Prescribing?”, Dr. Staub will address the growing popularity of retail clinics and the emergence of direct-to-consumer antibiotic products. What began with brick-and-mortar retail clinics inside pharmacies and stores is evolving into online models that allow consumers to obtain medications with little or no interaction with a clinician.
For stewardship experts, that shift raises important questions about accountability and oversight.
“As we’re getting further into the direct-to-consumer space, there seems to be less accountability structures and just infrastructure for stewardship,” Dr. Staub said.
The trend reflects genuine consumer demand, she noted. Patients increasingly seek convenient, affordable care and are frustrated by long waits and limited access to primary care services. Stewardship leaders, she argues, need to understand why these models are succeeding rather than simply criticizing them.
“We in ID need to be more aggressive about understanding that there is a reason there is a market here,” Dr. Staub said. “Patients are tired of waiting. They feel not supported.”
At the same time, she worries that direct-to-consumer antibiotic products could repeat mistakes seen in other health care systems where antimicrobials are widely available without adequate evaluation, contributing to antimicrobial resistance. Her presentation will explore how stewardship principles might be incorporated into these emerging models while preserving the convenience patients value.
Surgery Centers
Dr. Vassallo’s presentation, “Antimicrobial Stewardship in Ambulatory Surgery Centers,” will examine another rapidly growing health care setting. More than 6,300 ambulatory surgery centers serve millions of patients annually, yet formal antimicrobial stewardship programs are not required by either the Centers for Medicare and Medicaid Services or The Joint Commission.
Rather than viewing that as a barrier, Dr. Vassallo sees an opportunity.
“I see it as an easy win because outpatient surgery centers are very focused businesses that do only a small amount of things compared to, let’s say, a hospital,” she said.
Because most centers perform a limited range of procedures and use relatively few antibiotics, stewardship interventions may be simpler to implement than in complex hospital environments. Dr. Vassallo argues that facilities already collecting infection prevention data can readily begin monitoring antibiotic use as well.
“Tracking and trending antibiotic usage is not a huge request,” she said.
During the session, Dr. Vassallo will share a stewardship checklist, a policy template and patient education materials developed to help surgery centers evaluate and strengthen existing practices.