Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

Abstract

For decades, the performance of antimicrobial stewardship programs (ASPs) has been measured by incidence rates of hospital-onset Clostridioides difficile 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.

Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system

“…Thus, GI panel results impact interdepartmental shared metrics, making awareness and collaboration key to optimizing patient care. 6 The concept of diagnostic stewardship is used to offer organized guidelines for appropriate use of these rapid diagnostics and improved application to patient care. This includes guidance on identifying relevant patient populations for testing, as well as education on the nuances of newer technologies.…”

“…Thus, GI panel results impact interdepartmental shared metrics, making awareness and collaboration key to optimizing patient care. 6 …”

Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program

“…It is worthwhile to consider what measures reflect; total population volume (DDD, DOT), or individual exposure (prescriptions), denominated by population or hospital admissions, since they reflect on different aspects of quantitative use. 52 In order to better provide benchmarking for comparison, several ways of providing adjusted quantitative data for risk and setting have been proposed, 53–56 of which the CDC’s SAAR (Standardized Antimicrobial Administration Ratio) metric has gained the most attention.…”

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

“…In contrast, the proportion of extended-spectrum beta-lactamase (ESBL)–producing Escherichia coli increased, emphasizing the need for focused stewardship efforts outside the hospital walls [ 4 ]. Reducing unnecessary antimicrobial prescriptions and overall antimicrobial utilization remain valued metrics and pillars for successful antimicrobial stewardship teams to combat the untoward effects of antimicrobials [ 7 ].…”