Exploring unconventional antimicrobial stewardship models: options beyond traditional prospective audit and feedback

Area of Science:

• Infectious Diseases
• Hospital Administration
• Public Health

Background:

• Prospective audit and feedback (PAF) is a cornerstone of antimicrobial stewardship.
• The impact of discontinuing PAF in favor of other interventions has not been previously studied.

Purpose of the Study:

• To evaluate changes in antimicrobial days of therapy per 1,000 patient days (DOTs/1,000 PD) after removing PAF at two urban hospitals.
• To assess secondary outcomes including trends in specific antibiotic classes.

Main Methods:

• A descriptive study analyzing DOTs/1,000 PD before and after PAF removal.
• Postintervention focused on system standardization, education, guideline optimization, and EMR enhancements.
• Secondary outcomes included trends for MRSA, Pseudomonas aeruginosa, carbapenem, and oral antibiotics.

Main Results:

• Hospital A showed a significant decrease in DOTs/1,000 PD post-PAF removal. Carbapenem use also decreased significantly.
• Hospital B's DOTs/1,000 PD continued to trend downwards. However, use of anti-MRSA, anti-pseudomonal, and carbapenem agents increased.
• No significant changes were observed in oral antibiotic use or Clostridioides difficile rates at either hospital.

Conclusions:

• Shifting resources from PAF did not lead to increased overall antibiotic consumption.
• Modest increases in broad-spectrum antibiotic use were observed, but their clinical significance remains unclear.
• Continued assessment of antimicrobial stewardship strategies beyond PAF is essential to optimize effectiveness and resource allocation.