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Antibiotics 2016, 5(1), 5; doi:10.3390/antibiotics5010005

A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

1
Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, Hatfield, AL10 9AB, UK
2
NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
3
Antimicrobial Resistance Program, Public Health England, London, NW9 5EQ, UK
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Academic Editors: Christopher C. Butler and Jerod Nagel
Received: 28 September 2015 / Revised: 4 December 2015 / Accepted: 4 January 2016 / Published: 13 January 2016
(This article belongs to the Special Issue Antimicrobial Stewardship)
View Full-Text   |   Download PDF [227 KB, uploaded 13 January 2016]

Abstract

The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP. View Full-Text
Keywords: antimicrobial stewardship; antimicrobial resistance; quality indicators; outcome; patient; infectious diseases antimicrobial stewardship; antimicrobial resistance; quality indicators; outcome; patient; infectious diseases
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Akpan, M.R.; Ahmad, R.; Shebl, N.A.; Ashiru-Oredope, D. A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals. Antibiotics 2016, 5, 5.

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