Antimicrobial Stewardship Metrics that Matter
Wagner JL, Carreno JJ, Kenney RM, Kilgore PE, and Davis SL. Antimicrobial Stewardship Metrics that Matter. Infectious Diseases in Clinical Practice 2020; 28(2):89-93.
Infectious Diseases in Clinical Practice
Background Guidelines for antimicrobial stewardship programs (ASPs) highlight the need for measuring quality metrics as surrogate markers for outcome. The objective of this study was to determine the relationship between ASP quality metrics and patient outcomes at an institution with an established ASP. Methods Retrospective cohort study including 442 patients receiving intravenous antibiotics for 72 hours or more in 1 of 3 designated inpatient units were assessed for compliance with ASP metrics and associated outcomes. Clinical success was defined as discharged alive, without adverse drug reaction and not readmitted within 30 days of discharge. Results The mean (SD) age was 62 (17) years with 205 males (46%) enrolled. A total of 422 patients (96%) had documented indication for therapy, 365 (83%) had appropriate cultures obtained at baseline, 354 (80%) had appropriate empiric therapy at baseline, and 166 (83%) of 199 had appropriate deescalation performed. All metrics were met in 58% of patients. Sixty-two percent of patients achieved clinical success; while, 14% died, 13% had an adverse drug reaction, and 21% were readmitted within 30 days. Completion of all ASP metrics was not associated with clinical success (odds ratio, 0.862; P = 0.46). Documentation of indication for therapy was a significant indicator for clinical success (97.8% vs 91.7%; P = 0.003); this remained associated after adjusting for infection type and severity. Conclusions Documented indication showed strong association with clinical success, providing support for use of the Centers for Disease Control's Core Elements as a metric for quality of care.