159. Characterization of Suboptimal Discharge Antimicrobial Prescriptions and Effect of Inpatient Audit and Feedback on Quality of Antimicrobial Prescribing

Abstract Background Approximately 30% of children are discharged from the hospital with an antimicrobial prescription; nearly a third of these prescriptions are suboptimal. Although the best approach to antimicrobial stewardship of discharge prescriptions remains uncertain, prospective audit and feedback (PAF) has improved inpatient antimicrobial use. We aimed to identify and characterize suboptimal discharge antimicrobial prescribing and assess the impact of inpatient PAF on the quality of discharge antimicrobial prescribing at a free-standing children’s hospital. Methods A retrospective review of enteral discharge antimicrobial prescriptions between 12/1/20-5/31/21 and parenteral antimicrobial prescriptions sent to our hospital’s infusion pharmacy between 3/1/21-5/31/21 was performed to determine if suboptimal or not. A prescription was determined to be suboptimal if the antimicrobial choice, dose, frequency, duration, formulation, or indication was not consistent with institutional and/or national guidelines. Data collection included the antimicrobial, indication, and prescribing medical service. Prescriptions were evaluated for a corresponding inpatient PAF for the same drug and indication and then stratified based on inpatient PAF completion. Results A total of 1192 discharge prescriptions for 698 unique patients over 834 hospital encounters were reviewed. Overall, 243 (20%) prescriptions were identified as suboptimal; reasons were duration (16%), dose (8%), frequency (5%), or antimicrobial choice, formulation, or route (≤1%). Prescriptions for cephalexin had the highest rate of suboptimal prescribing (80/167, 48%), followed by amoxicillin-clavulanate (89/203, 44%). A corresponding inpatient PAF was identified for 675 (57%) of discharge antimicrobial prescriptions. Inpatient PAF prior to discharge resulted in fewer suboptimal discharge prescriptions for the same antimicrobial (8% vs. 36%, p < 0.001). Conclusion Antimicrobial prescribing at inpatient discharge was suboptimal in 1 of every 5 prescriptions. Inpatient PAF was associated with improved antimicrobial prescribing at hospital discharge. Antimicrobial stewardship programs should continue to explore ways to capture and intervene on antimicrobials prescribed at discharge. Disclosures Hayden T. Schwenk, MD, MPH, Nothing to disclose

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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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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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1141. Implementation of a Pediatric Handshake Antimicrobial Stewardship Program to Improve Antimicrobial Utilization

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1005 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S406-S406

Author(s):

Amanda P Hughes ◽

Maya Beganovic ◽

Ronda Oram ◽

Sarah Wieczorkiewicz ◽

Anthony Chiang

Keyword(s):

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Prescribing Practices ◽

Stewardship Program ◽

Antimicrobial Utilization ◽

Days Of Therapy ◽

Significant Difference ◽

Acceptance Rates ◽

Prospective Audit And Feedback ◽

The Impact

Abstract Background Antimicrobial stewardship (AMS) programs emerged in response to rising rates of resistance and adverse effects associated with inappropriate antimicrobial utilization. Optimal metrics and strategies (e.g., preauthorization, prospective audit and feedback) for AMS remain to be elucidated. This study evaluated the impact of a multidisciplinary, rounding-based AMS strategy (i.e., Handshake Stewardship) on antimicrobial utilization and prescribing practices at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a community, teaching children’s hospital. All pediatric and neonatal inpatients with active antimicrobial orders between July 2018 and March 2019 were included in the study, and endpoints were compared with data from July 2017- March 2018. Antimicrobial courses were prospectively audited by a multidisciplinary AMS team, and feedback was provided to the primary teams during Handshake Stewardship rounds. The primary endpoint was a number of interventions made and the corresponding acceptance rates. The secondary endpoint was days of therapy (DOT) per 1000 patient-days. Descriptive statistics were performed on all continuous and categorical data as appropriate. Results Of 2238 antimicrobial courses reviewed, 710 (32%) required intervention, and 86% of the interventions made were accepted. The top 3 indications evaluated were respiratory (n = 522, 23%), sepsis/bacteremia (n = 351, 16%), and surgical prophylaxis (n = 266, 12%). Of the respiratory courses reviewed, there were 228 opportunities for antimicrobial optimization. The most common interventions were: bug-drug optimization (n = 208, 29%), discontinuation of anti-infective (n = 136, 19%), and dose optimization (n = 120, 17%). No significant difference was observed for overall, ceftriaxone, meropenem, and vancomycin DOT pre- and post-implementation of Handshake Stewardship. However, a statistically significant reduction in DOTs was observed for piperacillin–tazobactam (15.2 vs. 7.4, P = 0.004) and a nonsignificant reduction in meropenem (9.5 vs. 6.2). Conclusion Rounding-based, Handshake AMS was associated with overall high intervention acceptance rates and a reduction in commonly utilized broad-spectrum antimicrobials. Disclosures All authors: No reported disclosures.

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When Antimicrobial Stewardship Isn′t Watching: The Educational Impact of Critical Care Prospective Audit and Feedback

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw115 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 4

Author(s):

Dimitra Fleming ◽

Karim F. Ali ◽

John Matelski ◽

Ryan D'Sa ◽

Jeff Powis

Keyword(s):

Critical Care ◽

Antimicrobial Stewardship ◽

Care Setting ◽

Audit And Feedback ◽

Antimicrobial Use ◽

Prospective Audit ◽

Educational Impact ◽

Antimicrobial Prescribing ◽

Stewardship Program ◽

Prospective Audit And Feedback

Abstract Prospective audit and feedback (PAF) is an effective strategy to optimize antimicrobial use in the critical care setting, yet whether skills gained during PAF influence future antimicrobial prescribing is uncertain. This multisite study demonstrates that knowledge learned during PAF is translated and incorporated into the practice of critical care physicians even when not supported by an antimicrobial stewardship program.

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A Novel Metric to Monitor the Influence of Antimicrobial Stewardship Activities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.54 ◽

2017 ◽

Vol 38 (06) ◽

pp. 721-723 ◽

Cited By ~ 5

Author(s):

Daniel J. Livorsi ◽

Erin O’Leary ◽

Tamra Pierce ◽

Lindsey Reese ◽

Katharina L. van Santen ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Antimicrobial Use ◽

Prospective Audit ◽

Infectious Disease Physician ◽

Antimicrobial Prescribing ◽

National Healthcare Safety Network ◽

Stewardship Program ◽

Prospective Audit And Feedback ◽

Antimicrobial Administration

The antimicrobial use (AU) option within the National Healthcare Safety Network summarizes antimicrobial prescribing data as a standardized antimicrobial administration ratio (SAAR). A hospital’s antimicrobial stewardship program found that greater involvement of an infectious disease physician in prospective audit and feedback procedures was associated with reductions in SAAR values across multiple antimicrobial categories. Infect Control Hosp Epidemiol 2017;38:721–723

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Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.85 ◽

2018 ◽

Vol 39 (07) ◽

pp. 806-813 ◽

Cited By ~ 5

Author(s):

Laura L. Bio ◽

Jenna F. Kruger ◽

Betty P. Lee ◽

Matthew S. Wood ◽

Hayden T. Schwenk

Keyword(s):

Antimicrobial Stewardship ◽

Primary Outcome ◽

Audit And Feedback ◽

Antimicrobial Stewardship Program ◽

Free Standing ◽

Logistic Regression Models ◽

Patient Level ◽

Stewardship Program ◽

Prospective Audit And Feedback

OBJECTIVETo identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children’s hospital.DESIGNRetrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.METHODSThe ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.RESULTSIn total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99–15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08–18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92–19.77), or had been admitted for 31–90 days at the time of the audit (OR, 2.08; 95% CI, 1.36–3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01–1.04).CONCLUSIONSEvaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.Infect Control Hosp Epidemiol 2018;806–813

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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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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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1065. Keeping Score: Utilizing a Prioritization Tool to Create Multidisciplinary Antimicrobial Stewardship Documentation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.929 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S377-S377

Author(s):

Krutika N Mediwala ◽

Brian R Raux ◽

Acshah Philip ◽

Amanda Parks ◽

Terry Dixon ◽

...

Keyword(s):

South Carolina ◽

Antimicrobial Stewardship ◽

Clinical Decision ◽

Audit And Feedback ◽

Multidisciplinary Communication ◽

Related Data ◽

Lower Priority ◽

Scoring Algorithm ◽

Prospective Audit And Feedback ◽

The Impact

Abstract Background A multidisciplinary approach using pre-authorization and/or prospective audit and feedback combined with institutional guidelines, personnel education, and intervention monitoring is essential for successful antimicrobial stewardship programs (ASP). Assessing the impact of ASPs can be process-based and/or outcome-based. Electronic medical record-based clinical decision support (CDS) tools can be used to prioritize stewardship interventions. Methods The Medical University of South Carolina (MUSC) transitioned from Theradoc® to Epic® for ASP surveillance and data collection in 2018. The ASP team developed a scoring algorithm with integral rules to identify and analyze inpatients who might require ASP interventions. The dynamic list captures and scores patients based on key infection-related data and prioritizes interventions. Additionally, we created a smart form flowsheet to streamline stewardship efforts for use by physicians and pharmacists. Accuracy of event capture was assessed during the buildout and via daily comparisons between Theradoc® and Epic®. Our goals are to optimize the treatment of potentially fatal infections (e.g., bacteremia) and delay emerging resistance. Results Our ASP module utilizes a scoring algorithm to identify and prioritize patients with positive blood or central nervous system cultures, other positive critical diagnostic tests, and high-risk antimicrobial use. Additional rules identify “bug-drug” mismatches, multiple positive cultures, and de-escalation opportunities. For example, the rules assign a high priority to patients with positive blood cultures and no prescribed antibiotics, but a lower priority score to restricted antimicrobial orders. We created a smart form flowsheet to document microorganism, presumed source, anti-infective use, ASP intervention, and acceptance of recommendations, allowing for multidisciplinary documentation outside of Epic® I-vents. Finally, we created a Reporting Workbench report which allows for monthly compilation and analysis of ASP interventions. Conclusion The MUSC Epic® ASP platform build showcases a CDS system that allows for streamlined, multidisciplinary communication, documentation, and analysis of outcomes. Disclosures All authors: No reported disclosures.

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Physicians’ attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals

Pharmacy Practice ◽

10.18549/pharmpract.2021.1.2192 ◽

2021 ◽

Vol 19 (1) ◽

pp. 2192

Author(s):

Nathalie Sayegh ◽

Souheil Hallit ◽

Rabih Hallit ◽

Nadine Saleh ◽

Rouba K. Zeidan

Keyword(s):

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Antimicrobial Stewardship Program ◽

National Guidelines ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Positive Attitudes ◽

Stewardship Program ◽

Prospective Audit And Feedback

Background: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program. Objectives: To examine physicians’ attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals. Methods: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians’ attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements. Results: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians’ autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents. Conclusions: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.

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