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

Alyssa B Christensen1, Gary L Cochran2, Sean N Avedissian2

  • 1Department of Pharmacy, HealthPartners Hospitals & Clinics, Minneapolis, MN, USA.

Infection Control and Hospital Epidemiology
|June 24, 2026
PubMed
Abstract

Insights

Discontinuing prospective audit and feedback (PAF) did not increase overall antibiotic use. Alternative antimicrobial stewardship strategies require ongoing evaluation for optimal effectiveness.

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.

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