Evaluating the Prevalence of Leading Practices in Antimicrobial Stewardship

Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.Funding: The Pew Charitable TrustsDisclosures: None

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1059. Impact of a Syndrome-Based Antimicrobial Stewardship Intervention on Anti-Pseudomonal β-Lactam Use, C. difficile Rates and Cost in an Urban Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.923 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S374-S375

Author(s):

Alfredo J Mena Lora ◽

Martin Cortez ◽

Ella Li ◽

Lawrence Sanchez ◽

Rochelle Bello ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Community Hospital ◽

Treatment Guidelines ◽

Urban Community ◽

Audit And Feedback ◽

Evidence Based ◽

Days Of Therapy ◽

Before And After ◽

Prospective Audit And Feedback ◽

The Impact

Abstract Background The use of anti-Pseudomonal β-lactam (APBL) agents has significantly increased in the past decade, carrying higher costs and contributing to antimicrobial pressure. Antimicrobial stewardship (ASP) can promote evidence-based antimicrobial selection and mitigate excess APBL use. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback (PAF) at an urban community hospital. The goal of this study is to assess the impact of syndrome-based PAF on APBL use, C. difficile rates and cost. Methods ASP with all CDC core elements was implemented at a 151-bed community hospital in October 2017. Syndrome-based guidelines and PAF was established and overseen via direct communication with an ID physician. Days of therapy (DOT), cost and C. difficile rates were assessed 12 months before and after ASP. DOT for APBL and non-APBL utilization was tabulated by unit and paired t-test performed. Results Most cases reviewed by PAF (51%) were represented in our syndrome-based treatment guidelines (Figure 1). Soft tissue (33%) and intra-abdominal (24%) infections were the most common syndromes. Change to guideline was the most common PAF intervention (62%) followed by de-escalation (30%). At 12 months, total DOT/1,000 increased (392.5 vs. 404) while the proportion of parenteral antimicrobials used decreased (71% vs. 65%). Antibiotic expenditures decreased by 23%, with a reduction in APBL of 20% and non-APBL of 10% (Table 1). Statistically significant reductions APBL use in non-ICU settings (P = 0.0139) and statistically significant increases in non-APBL in ICU settings occurred (P = 0.0001) (Figure 2 and 3). C difficile rates decreased from 21% (3.27 vs. 2.56). Conclusion Syndrome-based PAF was successfully implemented. A reduction in APBL use was seen in non-ICU settings, where evidence-based de-escalation may be more feasible. APBL use remained high in the ICU but was guideline consistent. A rise in non-APBL use also occurred. Certain critical illness syndromes warrant APBLs, but PAF may promote culture-directed and syndrome-specific treatments. ASP increased guideline-based therapy and contributed to decreased broad-spectrum antimicrobial use, antimicrobial expenditures and C difficile rates. Syndrome based PAF can be successfully implemented in community settings. Disclosures All authors: No reported disclosures.

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83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.128 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S58-S59

Author(s):

Casey J Dempsey ◽

Natasha Weiner ◽

Michele Riccardi ◽

Kristin Linder

Keyword(s):

Antimicrobial Stewardship ◽

Community Hospital ◽

Audit And Feedback ◽

Small Community ◽

Prospective Audit ◽

Post Intervention ◽

Days Of Therapy ◽

Prospective Audit And Feedback ◽

The Impact ◽

Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p < 0.001), ciprofloxacin (23.22 vs. 9.97; p < 0.001), levofloxacin (11.2 vs. 5.07; p < 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p < 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p < 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p < 0.001), levofloxacin ($2,168 vs. $672; p < 0.001), ciprofloxacin ($6,700 vs. $1,954; p < 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p < 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

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The implementation and outcome of a 2-year prospective audit and feedback based antimicrobial stewardship program at a private tertiary care hospital

10.1101/2021.01.29.21250434 ◽

2021 ◽

Author(s):

Pooja Thakkar ◽

Tanu Singhal ◽

Sweta Shah ◽

Rohit Bhavsar ◽

Shweta Ladi ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Audit And Feedback ◽

Care Hospital ◽

Prospective Audit ◽

Colistin Resistance ◽

Days Of Therapy ◽

Prospective Audit And Feedback ◽

Resistance Rates

AbstractPurposeAntimicrobial resistance has emerged as a major public health problem with India being one of the worst affected nations. Hence effective antimicrobial stewardship programs (AMSP) are needed. We report the design, implementation and results of a prospective audit and feedback based AMSP at a private tertiary care hospital.MethodsDuring the study period – January 2018 to December 2019 – the prescription of restricted antimicrobials required the filling of a justification form which was reviewed by the antimicrobial stewardship committee (AMSC) at 48-72 hours. Patients in whom the restricted antimicrobial was stopped earlier than 48 hours were not applicable for review. The eligible prescriptions were judged as justified/unjustified by AMSC based on the patient’s clinical and previous antimicrobial history, course and results of investigations/ cultures, and communicated to the treating team. Compliance to the recommendations of the AMSC was measured. Days of therapy for each restricted antimicrobial/1000 patient days was calculated. Colistin resistance rates in pathogens causing central line associated blood stream infections were compared with previous years.ResultsA total of 2397 restricted antimicrobials in 1366 patients were prescribed in the study period of which 1801 prescriptions were applicable for review (75%). Overall, 1.4% of admitted patients were prescribed restricted antimicrobials. The total days of therapy with restricted antimicrobials was 41.5/1000 patient days. The AMSC committee adjudged 12.5% of prescriptions as unjustified and recommendations for de-escalation were accepted in 89%. There was no significant difference in any of the study outcomes between 2018 and 2019. Colistin resistance rates in CLABSI remained stable as compared to previous years.ConclusionThe prospective audit and feedback component of AMSP provides insights into the use of restricted antimicrobials. This component should be considered by hospitals for inclusion in their program on an ongoing basis even if limited for a few drugs and in few areas of the hospital.

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38. Impact of Antimicrobial Stewardship Interventions on Adherence to Clostridioides difficile Treatment Guidelines

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.240 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S141-S141

Author(s):

Elizabeth Neuner ◽

Tamara Krekel ◽

Michael Durkin ◽

Erik R Dubberke ◽

Kevin Hseuh

Keyword(s):

Antimicrobial Stewardship ◽

Treatment Guidelines ◽

Treatment Guideline ◽

Small Sample ◽

Audit And Feedback ◽

Prospective Audit ◽

Research Support ◽

Post Intervention ◽

Prospective Audit And Feedback ◽

The Impact

Abstract Background Facility-specific treatment guidelines are a priority intervention recommended in the CDC Core Elements of Hospital Antimicrobial Stewardship Programs (ASPs). Our ASP sought to improve adherence to the facility C. difficile infection (CDI) treatment guideline by implementing prospective audit and feedback of CDI cases, changing fidaxomicin from being restricted to Infectious Diseases consult use, to only requiring prospective audit and feedback, and allowing fidaxomicin and oral vancomycin orders only through the order set. This study reviews the impact of these interventions. Methods This single-center retrospective quasi-experimental study evaluated inpatient CDI lab events 3 months pre-intervention (10/1/2019-12/31/2019) and post-intervention (10/14/2020-1/14/2021). Patient and treatment data was evaluated via chart review. The primary outcome was adherence to CDI treatment guideline. ASP intervention types were categorized. Statistical analyses were performed using Chi-squared or Fischer’s exact, where appropriate. Results Baseline characteristics were well matched between the 58 and 70 patients pre and post intervention respectively (Table 1). ASP interventions resulting from the prospective audit and feedback are described in Table 2 and overall acceptance rates were high (88%). Guideline adherence improved significantly from 71% pre to 90% post-intervention (p=0.005). Reasons for non-adherence included vancomycin dose incorrect for the severity of illness (9 pre vs 2 post), inappropriate duration (4 pre vs 0 post), use of combination therapy in non-fulminant disease (5 pre vs 3 post), and not using fidaxomicin for recurrent disease (3 pre vs 2 post). Clinical outcomes pre and post intervention were not different in this small sample size: colectomy 1 (2%) vs 1 (1%) p=1, 60 day all- cause mortality 15 (26%) vs 14 (20%) p=0.43, and CDI recurrence at day 60 9/43 (21%) vs 5/56 (9%) p=0.131. Conclusion A bundle of ASP interventions including prospective audit and feedback of CDI cases improved adherence to facility-specific CDI treatment guidelines. Disclosures Tamara Krekel, PharmD, BCPS, BCIDP, Merck (Speaker’s Bureau) Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support)Seres (Consultant)Summit (Consultant)

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71. Impact of Prospective Audit and Feedback on Fluoroquinolone Use: A Large Academic Medical Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.116 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S54-S54

Author(s):

Julio C Simon ◽

Ana Vega

Keyword(s):

Antimicrobial Stewardship ◽

Statistical Significance ◽

Academic Medical Center ◽

Qt Prolongation ◽

Prescribing Patterns ◽

Audit And Feedback ◽

Hospital Length Of Stay ◽

Prospective Audit ◽

Days Of Therapy ◽

Prospective Audit And Feedback

Abstract Background Fluoroquinolones are an effective class of antimicrobials; however, their use is not without consequence. Recent warnings have resulted in the FDA recommending to reserve this class for infections lacking alternative options. Antimicrobial stewardship significantly reduces targeted antimicrobial use, improves susceptibility patterns, decreases rates of Clostridium difficile infection (CDI), and reduces healthcare-associated costs. Literature on fluoroquinolone stewardship by antimicrobial stewardship programs report similar outcomes in addition to reductions in rates of extended-spectrum beta-lactamase (ESBL)-producing and methicillin-resistant S. aureus (MRSA) infection. Methods This study was a retrospective cohort study of adult patients receiving at least 3 days of a fluoroquinolone for an indication of pneumonia or urinary tract infection. Retrospective orders were assessed for prescribing patterns, duration of therapy, and antibiotic choice by indication. The primary outcome was reduction of fluoroquinolone consumption as a result of a prospective audit and feedback intervention, determined with days of therapy (DOT) and DOT per 1000 patient days. Secondary outcomes included hospital length-of-stay (LOS), 3-month post-exposure incidence of CDI, ESBL and MRSA infections, percentage of interventions accepted, and QT prolongation events. Mann-Whitney U was used to determine statistical significance for DOT and LOS, unpaired student t-test was used for DOT per 1000 patient days. Results 333 patients were reviewed. Fluoroquinolone median days-of-therapy (DOT) was significantly reduced in the intervention phase (7 vs. 4 days, P < 0.001). Median LOS was 8 days for the cohort and did not differ between groups. After adjusting for identifiable alternative causes, no difference in QT prolongation, CDI or ESBL infection was observed. However, these results were limited by lack of diagnostic testing for QT prolongation and inability to assess for other contributing factors related to infection control. Conclusion Antimicrobial stewardship is an effective intervention to reduce fluoroquinolone use. An increased LOS was not observed despite patients switching to parenteral therapies. More data is needed to assess differences related to adverse events. Disclosures All Authors: No reported disclosures

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Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.10 ◽

2021 ◽

pp. 1-8

Author(s):

Katie J. Suda ◽

Gosia S. Clore ◽

Charlesnika T. Evans ◽

Heather Schacht Reisinger ◽

Ibuola Kale ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Clinical Pathways ◽

Statistical Significance ◽

Implementation Strategies ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prior Approval ◽

Days Of Therapy ◽

Prospective Audit And Feedback ◽

Advanced Generation

Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

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157. A Multidisciplinary Approach to Carbapenem Stewardship at a Large Community Hospital in Brooklyn, New York

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.202 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S88-S88

Author(s):

Samuel Simon ◽

Rosanna Li ◽

Yu Shia Lin ◽

Suri Mayer ◽

Edward Chapnick ◽

...

Keyword(s):

New York ◽

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Chi Square ◽

Carbapenem Resistant ◽

Days Of Therapy ◽

Prospective Audit And Feedback

Abstract Background Carbapenem-resistant gram-negative organisms are a continuously mounting threat, underscoring the need for effective antimicrobial stewardship interventions to improve the use of carbapenems. We sought to implement several multidisciplinary antimicrobial stewardship interventions beginning in January 2019 in an effort to reduce unnecessary meropenem use and the incidence of carbapenem-resistant gram-negatives. Methods Prospective audit and feedback was utilized daily in combination with weekly stewardship rounds between an Infectious Diseases pharmacist and physician in the Intensive Care Units. A second Infectious Diseases physician attended weekly interdisciplinary rounds on meropenem high-use units. Meropenem Days of Therapy (DOT) per 1,000 patient days and the incidence of meropenem resistant Pseudomonas aeruginosa and Klebsiella pneumoniae were compared by the chi-square test of proportions. Results Between 2018 and 2019 the institution’s meropenem DOT per 1,000 patient days decreased 33%, from 57 to 38 days per 1,000 patient days (difference, 19 days per 1,000 patient days; p< 0.001). In the hospital antibiogram, the meropenem susceptibility of Pseudomonas aeruginosa over the same time period increased from 71% to 77% of isolates (difference, 6%; p = 0.009). A non-significant decrease in the susceptibility of meropenem to Klebsiella pneumoniae was also observed from 92 to 90% (difference, 2%: p = 0.1658). Conclusion These data support the need for antimicrobial stewardship efforts targeting broad-spectrum antimicrobials such as meropenem. In the setting of a sustained decrease in meropenem use over 12 months, we observed a significant improvement in the percent susceptibility rate of Pseudomonas aeruginosa to meropenem for the first time in five years. Disclosures All Authors: No reported disclosures

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Targeted Outpatient Fluoroquinolone Intervention utilizing an Integrated Electronic Health Record in the Bureau of Prisons

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1048 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s402-s402

Author(s):

Deborah Long ◽

Alisha Edmunds ◽

Tyler Campbell ◽

Michael Long

Keyword(s):

Electronic Health Record ◽

Antimicrobial Stewardship ◽

Singular System ◽

Audit And Feedback ◽

Health Record ◽

Prospective Audit ◽

Short Period ◽

Electronic Health ◽

Prospective Audit And Feedback ◽

Bureau Of Prisons

Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time.Funding: NoneDisclosures: None

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Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.121 ◽

2018 ◽

Vol 39 (8) ◽

pp. 941-946 ◽

Cited By ~ 2

Author(s):

Bradley J. Langford ◽

Julie Hui-Chih Wu ◽

Kevin A. Brown ◽

Xuesong Wang ◽

Valerie Leung ◽

...

Keyword(s):

Observational Study ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prospective Audit ◽

Defined Daily Doses ◽

Prospective Audit And Feedback ◽

The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

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