A hospital notes a rise in plasmid-encoded aminoglycoside-modifying enzymes across several Enterobacterales isolates. Which stewardship strategy is most appropriate to limit spread and preserve aminoglycoside utility?

• A. Use aminoglycosides prophylactically in all surgical patients to maintain selective pressure that will eradicate plasmid-carrying strains faster than they spread, thereby reducing resistance prevalence.
• B. Implement infection control to limit transmission, restrict empirical aminoglycoside use to situations with clear indication and susceptibility data, and promote combination therapy or alternative agents guided by susceptibility testing to reduce selective pressure for plasmid spread.
• C. Stop all use of aminoglycosides in the hospital immediately and replace them with chloramphenicol for all infections, because chloramphenicol has no resistance mechanisms and is safe for widespread use.
• D. Continue current aminoglycoside prescribing practices since plasmid-mediated resistance will inevitably spread regardless of stewardship efforts, making intervention futile.

Answer: (B)