Antimicrobial stewardship: a matter of process or outcome?

Area of Science:

• Infectious Diseases
• Healthcare Management
• Clinical Pharmacy

Background:

• Rising rates of hospital-acquired infections, antimicrobial resistance, and superinfections necessitate improved antimicrobial use.
• Limited development of novel antimicrobials exacerbates the challenge of increasing resistance.
• Antimicrobial stewardship programs (ASPs) have evolved from cost-saving measures to quality assessment tools for antimicrobial prescribing.

Purpose of the Study:

• To highlight the importance of comprehensive evaluation of antimicrobial stewardship programs (ASPs).
• To discuss the limitations of current evaluation methods for ASPs.
• To advocate for the combined use of process and outcome measures in ASP assessment.

Main Methods:

• Review of existing literature on antimicrobial stewardship program evaluation.
• Analysis of the strengths and limitations of process measures and outcome measures.
• Discussion of the necessity for integrated evaluation strategies.

Main Results:

• Process measures effectively assess the quality of care but do not fully capture patient-level clinical impact.
• Outcome measures are essential for assessing clinical objectives but are not direct indicators of care quality.
• Current evaluations of ASP effectiveness often rely solely on process measures, potentially underestimating program impact.

Conclusions:

• Effective evaluation of ASPs requires a dual approach combining validated process measures with meaningful outcome measures.
• Integrating both measure types is crucial for confirming intervention goals and achieving clinical objectives.
• A comprehensive evaluation strategy will strengthen evidence for expanding current ASPs and developing new ones.