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  1. The development and spread of antibiotic resistance is multi-factorial and studies assessing the impact of improved antibiotic use on resistance rates have shown mixed results.(97-99) The impact of stewardship interventions on resistance is best assessed when measurement is focused on pathogens that are recovered from patients after admission (when patients are under the influence of the stewardship interventions). what percent of patients develop resistant super-infections) has also been shown to be useful (99) Stewardship programs can result in significant annual drug cost savings and even larger savings when other costs are included.(18, 20, 21, 100) These savings have been helpful in garnering support for antibiotic stewardship programs.