As the infectious disease consultant, synthesize an antibiotic stewardship plan for a hospital facing rising carbapenem use due to ESBLs, outlining three concrete policies that preserve carbapenems while effectively treating beta-lactamase producers.

Implement (1) prompt diagnostic stewardship with rapid susceptibility testing to de-escalate therapy when appropriate, (2) preferential use of beta-lactam/beta-lactamase inhibitor combinations guided by in vitro susceptibility for non-severe infections to spare carbapenems, and (3) restricted carbapenem use reserved for severe, high-inoculum, or confirmed carbapenemase-producing infections with mandatory ID approval—this multi-pronged approach balances efficacy and resistance containment.

Mandate universal empiric carbapenem therapy for all hospitalized infections because immediate broad coverage prevents mortality and will not affect long-term resistance patterns; reporting of susceptibilities can be delayed to avoid clinician confusion.

Allow unrestricted over-the-counter access to carbapenems for prophylactic use in all surgical patients because high usage will quickly eliminate ESBL-producing populations by selection pressure, paradoxically resolving the resistance problem.

Ban use of beta-lactamase inhibitors entirely and rely on topical disinfectants to reduce infection incidence because antibiotic stewardship is best achieved by eliminating combination drugs that confuse prescribing choices.