Prevention and management of multidrug-resistant organisms (MDROs) is an important goal of healthcare but often difficult to achieve with available hospital information systems. Clinical surveillance systems (CSSs) can help identify patients with or at risk for MDROs and target populations for antimicrobial stewardship. We report our experience with the implementation of a CSS at a Veterans Administration medical centre to improve efficiency of our infection control program and to develop and implement antimicrobial stewardship. This has resulted in improved patient outcomes, reductions in adverse drug events and antimicrobial costs and enhanced surveillance and tracking of MDROs.