SCAT is an important strategy for decreasing selection pressure for the evolution and spread of MDR pathogens. SCAT is also valuable for improving patient outcomes and decreasing healthcare costs. Data presented in this chapter indicate that SCAT is effective for a spectrum of outpatient and inpatient infections. There is a need for more studies to better define the spectrum of infections and the more effective antibiotic regimens and to identify the most suitable patients for SCAT therapy. Recent guidelines for the management of pneumonia, UTIs, and BSIs have been published, but as we pointed out, there is often a lag period before these guidelines are implemented and evaluated in clinical practice.

SCAT has many advantages and potential disadvantages underscoring the need for rigorous study design and analysis. With the limited availability of new antimicrobial agents and the increased spread of MDR pathogens in our aging and more at-risk populations, it is imperative that we use our current resources wisely and continue to search for new anti-infective agents, as well as to explore better methods for the control and effective use of available antimicrobial agents. These initiatives must include the pharmaceutical industry, societies (IDSA, ATS, Society of Healthcare Epidemiologists of America, and the Association for Professionals in Infection Control), and state, federal, and international agencies. These groups could set an agenda to examine new ideas and work together to maximize our current knowledge and implement intervention strategies. Clearly, there is also a need for improved professional and public education, with more oversight by various regulatory agencies to emphasize and promulgate principles and practice for prevention of infections and quality improvement.

Hopefully, the data discussed in this chapter will be a catalyst for more interventions and use of methods to evaluate and monitor local and national antibiotic utilization and misuse. The key is to expand and continue a dialogue, coupled with specific goals and targets supported by more focused research support at multiple levels designed to improve current and future practices.

Although there has been progress in our understanding and practice of SCAT, there is still ample room for improvement. Our goals should be to push the envelope, think outside of the box, and to implement intervention strategies aimed at better infection control, risk reduction, education, and use of prophylaxis. There is clearly a need for change, but change will require leadership, a feasible strategic plan, incentives, appropriate resources, effective collaborations, and a commitment to developing new models.

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