Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes

Abstract

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

Keywords: antibiotics; antimicrobial resistance; antimicrobial stewardship; cost effectiveness; prospective audit and feedback; quasi-experimental study design.

Figure 1. General workflow schematic for a two-step prospective audit and feedback strategy as well as formulary restriction and preauthorization strategy for antimicrobial stewardship. Added details for prospective audit and feedback pertain to the workflow at the authors’ institute.