Friday, June 7, 2019

Antibiotic stewardship

Q: All of the following are considered valid outcome measures of Antimicrobial stewardship except?

A) Rate of double coverage at the initiation of therapy 
B) Hospital and ICU length of stay (LOS)
C) Readmission rates
D) C. difficile infection rates
E) Emergence of antimicrobial resistance over time

Answer: A

In the United States, the Joint Commission required all hospitals to implement antimicrobial stewardship programs. There are two major categories for evaluation of the stewardship program, each consist of five metrics

1) Process measures
2) Outcome measures

Process measures 
  • Unnecessary days of therapy 
  • Duration of therapy 
  • Proportion of patients compliant with facility-based guideline
  • Proportion of patients with revision of antibiotics based on microbiology data 
  • Proportion of patients converted to oral therapy 

Outcome measures
  • Hospital LOS
  • 30-day mortality 
  • Unplanned hospital readmission within 30 days 
  • Proportion of patients with hospital-acquired C. difficile or other adverse event(s) related to antibiotics
  • Proportion of patients with clinical failure 



Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016; 62(10):e51-77

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