Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Antimicrobial Stewardship

Background:

• Antimicrobial resistance necessitates effective antimicrobial stewardship programs (ASPs).
• Prospective audit and feedback recommendations (PAFR) are a key component of ASPs.
• Understanding factors influencing adherence to PAFR is crucial for optimizing ASP effectiveness.

Purpose of the Study:

• To identify predictors of provider disagreement with PAFR in a pediatric hospital setting.
• To analyze patient-level, antimicrobial-level, programmatic, and provider-level factors associated with PAFR non-adherence.

Main Methods:

• Retrospective cohort study analyzing 4,727 antimicrobial audits from March 2015 to April 2017.
• Logistic regression models were used to assess potential predictors of disagreement with PAFR.
• Primary outcome was disagreement with PAFR, with follow-up on recommendation adherence.

Main Results:

• 28% of PAFR and 15% of specific recommendations were not followed due to disagreement.
• Disagreement was higher for gastrointestinal infections (OR 5.50), febrile neutropenia (OR 6.14), and skin/soft-tissue infections (OR 6.16).
• Longer admission duration (31-90 days) and greater provider experience (OR 1.02 per year) were associated with increased disagreement.

Conclusions:

• Patient-specific diagnoses and provider experience are significant predictors of disagreement with PAFR.
• Current stewardship interventions may be insufficient without addressing these identified factors.
• Addressing provider-level and patient-level complexities is essential for successful antimicrobial stewardship.