Impact of Adherence With In-Patient Prospective Audit and Feedback Recommendations on Patient and Economic Outcomes

Prospective audit and feedback (PAF) are an antimicrobial stewardship intervention that reduces use of broad-spectrum antimicrobials among in-patients. The objective of this study was to assess the impact of adherence to PAF recommendations on the duration of broad-spectrum antimicrobials and patient outcomes.

This retrospective cohort study included adult in-patients at two tertiary care hospitals in St. John's, Newfoundland and Labrador Canada. PAF included all prescriptions for piperacillin/tazobactam, meropenem, ertapenem, and imipenem, reviewed by an infectious disease specialist on day 3 of therapy, with recommendations provided in the electronic medical record. The primary outcome was duration of treatment following PAF. Secondary outcomes were time to all-cause mortality, time to readmission, length of stay, and time to Clostridiodes difficile infection. Adherence categories were compared.

Of the recommendations, 394 out of 786 (50.1%) were completely followed, 18.3% were partially followed, and 31.6% were not followed. There were no significant differences in adherence category based on patient age (p = 0.48) or sex (p = 0.93). Adherence category was associated with a graded reduction in mean duration of target antimicrobial treatment following PAF (p < 0.001), and length of stay after PAF (p < 0.05). Adherence category was not associated with mortality (log-rank = 0.58), readmission rate (log-rank p = 0.33), C. difficile DNA (log-rank p = 0.24) or C. difficile toxin (log-rank p = 0.084).

Adherence to PAF reduces antimicrobial use and length of stay without creating harms, such as readmission. This shows that PAF can be beneficial, and future research should be tailored to increasing adherence to PAF recommendations.