Evaluation of a hybrid antimicrobial restriction process at a large academic medical center

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Health Services Research

Background:

• Antimicrobial resistance necessitates robust stewardship programs.
• Hybrid antimicrobial restriction processes combine prospective and retrospective review.
• Optimizing antimicrobial use is crucial for patient outcomes and preventing resistance.

Purpose of the Study:

• To evaluate adherence to appropriate use criteria within a hybrid antimicrobial restriction program.
• To assess the impact of the hybrid process on antimicrobial prescribing patterns.
• To identify potential areas for improvement in antimicrobial stewardship.

Main Methods:

• Retrospective review of antimicrobial orders.
• Analysis of adherence rates for provisional-only, provisional followed by infectious disease (ID), and ID-initiated orders.
• Evaluation of therapy interruptions in specific order pathways.

Main Results:

• Adherence to appropriate use criteria was 72% for provisional-only orders.
• 100% adherence was observed for provisional orders followed by ID orders.
• 97% adherence was achieved for ID-initiated orders.
• Therapy interruptions occurred in 24% of provisional orders followed by ID orders.

Conclusions:

• The hybrid antimicrobial restriction process demonstrates strong adherence to appropriate use criteria.
• While effective, the process may lead to therapy interruptions in certain pathways.
• Further refinement of the provisional order pathway could enhance antimicrobial stewardship efficiency.