Evaluation of antimicrobial orders with expanded indication for use

Area of Science:

• Infectious Diseases
• Health Services Research
• Clinical Pharmacy

Background:

• Antimicrobial stewardship programs are crucial for combating antimicrobial resistance.
• Accurate tracking of antimicrobial orders requires detailed indication data.
• Identifying the infectious source is key for appropriate antimicrobial therapy selection.

Purpose of the Study:

• To assess the effect of mandatory infectious source selection on systemic antimicrobial orders.
• To enhance antimicrobial stewardship tracking capabilities.
• To evaluate the utility of structured source selection for quality improvement.

Main Methods:

• A multicenter quality improvement project involving 17 hospitals and 21 emergency departments.
• Analysis of 57,118 inpatient and emergency department antimicrobial orders placed during September 2024.
• Evaluation of primary outcome (prevalence of selected infectious sources) and secondary outcomes (indication frequency, free-text use, concordance).

Main Results:

• Empiric indication accounted for the majority (71%) of antimicrobial orders.
• The most frequent infectious sources identified were respiratory (23%), urinary/renal (19%), and skin/soft tissue (16%).
• High concordance (95%) was observed between selected and documented sources, with limited free-text use (2.6%).

Conclusions:

• Mandatory infectious source selection provides valuable data for antimicrobial stewardship.
• The findings support the integration of structured source selection into routine antimicrobial ordering processes.
• This approach facilitates targeted stewardship interventions and improves antimicrobial use surveillance.