Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

• Published in: Antibiotics (Basel) Vol. 8; no. 3; p. 127
• Main Authors: Al-Hasan, Majdi N, Winders, Hana Rac, Bookstaver, P Brandon, Justo, Julie Ann
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 24.08.2019; MDPI
• Subjects: Acinetobacter baumannii; Algorithms; Anti-infective agents; antibiotic utilization; Antibiotics; Antigens; Antiinfectives and antibacterials; Antimicrobial agents; Bacteria; broad-spectrum agents; carbapenem-resistant Enterobacteriaceae; Collaboration; Disease control; Diseases; Dosage and administration; Drug resistance; Electronic health records; Electronic medical records; Electronic records; Epidemiology; extended-spectrum beta-lactamases; Health care; hospital epidemiology; Hospital patients; Hospitalization; Hospitals; Infection; infection control; infection prevention; Informatics; Information technology services; Intervention; Laboratories; Medical care quality; Medical informatics; Medical records; Methicillin; methicillin-resistant Staphylococcus aureus; Microbial drug resistance; Microbiology; Multidrug resistance; Narratives; Nosocomial infections; Patient safety; Patients; Performance evaluation; Prevention; Pseudomonas aeruginosa; Reimbursement; resistance; Review; Staphylococcus aureus infections; Staphylococcus infections; United States; United States > US; carbapenem-resistant Enterobacteriaceae; extended-spectrum beta-lactamases; hospital epidemiology; Acinetobacter baumannii; Antibiotics; broad-spectrum agents; antibiotic utilization; Pseudomonas aeruginosa; methicillin-resistant Staphylococcus aureus; infection control; resistance; infection prevention
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics8030127

For decades, the performance of antimicrobial stewardship programs (ASPs) has been measured by incidence rates of hospital-onset and other infections due to multidrug-resistant bacteria. However, these represent indirect and nonspecific ASP metrics. They are often confounded by factors beyond an ASP's control, such as changes in diagnostic testing methods or algorithms and the potential of patient-to-patient transmission. Whereas these metrics remain useful for global assessment of healthcare systems, antimicrobial use represents a direct metric that separates the performance of an ASP from other safety and quality teams within an institution. The evolution of electronic medical records and healthcare informatics has made measurements of antimicrobial use a reality. The US Centers for Disease Control and Prevention's initiative for reporting antimicrobial use and standardized antimicrobial administration ratio in hospitals is highly welcomed. Ultimately, ASPs should be evaluated based on what they do best and what they can control, that is, antimicrobial use within their own institution. This narrative review critically appraises existing stewardship metrics and advocates for adopting antimicrobial use as the primary performance measure. It proposes novel formulas to adjust antimicrobial use based on quality of care and microbiological burden at each institution to allow for meaningful inter-network and inter-facility comparisons.