Objective To explore how to build a scientific management mechanism of antimicrobial stewardship (AMS), provide reference for strengthening the management of antimicrobial agents and curbing the trend of bacterial resistance in medical institutions. Methods Based on the strategy AMS, the AMS team was established in Xiangya Hospital of Central South University to standardize the clinical use of antimicrobial agents. Nine indexes in three dimensions were selected to build assessment system for clinical application of antimicrobial agents, and changes in nine indexes of clinical application of antimicrobial agents before (2016) and after (2017-2020) the implementation of AMS were comprehensively assessed and analyzed by technique for order preference by similarity to ideal solution (TOPSIS). Results From 2016 to 2020, the evaluation index of antimicrobial application in the hospital was significantly improved, antimicrobial use density (AUD) in hospitalized patients decreased from 53.39 in 2016 to 36.55 in 2020, with a decrease of 31.54%; antimicrobial use rate in hospitalized patients decreased by 10.76%, the average cost of antimicrobial agents in hospitalized patients decreased by 41.45%, antimicrobial use rate in outpatient and emergency patients decreased by 31.59% and 43.53% respectively, utilization rate of special use antimicrobial agents decreased by 47.89%, AUD of special use antimicrobial agents decreased by 38.52%, detection rate of multidrug-resistant organism decreased by 9.89%, prevalence rate of HAI decreased by 37.50%. TOPSIS evaluation results showed that the application of antimicrobial agents in 2020 was the best during five years. Conclusion AMS is helpful to promote the rational application of antimicrobial agents in medical institutions, and curb the development of resistance of bacteria.