Background In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program sites in 10 states each recruited ≤25 general and women’s and children’s hospitals. Hospitals selected a survey date from May–September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6–50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Conclusions Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

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Amid pressure to increase the efficiency and effectiveness of the International Criminal Court (ICC), work has progressed on the development of a set of performance indicators for the ICC. This article argues that performance indicators play into tensions that underpin the international criminal justice process at the ICC, in particular between expeditiousness, on the one hand, and fairness and victim satisfaction, on the other. It argues that while the ICC’s performance indicators extend assessment of the ICC beyond the speedy completion of cases and embrace goals of fairness and victim access to justice, they inevitably support the former to the detriment of the latter, with implications for the Court’s identity. While acknowledging the benefits of performance indicators for the ICC, the article outlines several measures to counter the risks that they pose for the balance between these goals.

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In recent years, international criminal justice mechanisms have come under increasing pressure to improve their efficiency, i.e. to reduce costs and increase their speed of operation. Drawing from semi-structured interviews with staff and stakeholders in proceedings at the International Criminal Court, the International Criminal Tribunal for the Former Yugoslavia and the Extraordinary Chambers in the Courts of Cambodia, this article argues that pressure for efficiency and related reform is supporting ‘quiet transformation’ in the balance between conflicting goals that underpin the international criminal justice process; in particular, between the pursuit of accountability, on the one hand, and demand for fairness and victim satisfaction, on the other. It highlights the need for greater engagement with the underlying policy issues that efficiency building raises and for ongoing, sustained empirical research into the impact of efficiency building on the ability of international criminal courts and tribunals to realise their goals.