Background Antimicrobial stewardship (AMS) programs promote appropriate use of antimicrobials and reduce antimicrobial resistance. Technological developments have resulted in smartphone applications (apps) facilitating AMS. Yet, their impact is unclear. Objectives Systematically review AMS apps and their impact on prescribing by physicians treating inhospital patients. Data sources EMBASE, MEDLINE (Ovid), Cochrane Central, Web of Science and Google Scholar. Study eligibility criteria Studies focusing on smartphone or tablet apps and antimicrobial therapy published from January 2008 until February 28th 2019 were included. Participants Physicians treating in-hospital patients. Interventions AMS apps Methods Systematic review.

IntroductionWith the widespread use of electronic health records and handheld electronic devices in hospitals, informatics-based antimicrobial stewardship interventions hold great promise as tools to promote appropriate antimicrobial drug prescribing. However, more research is needed to evaluate their optimal design and impact on quantity and quality of antimicrobial prescribing.Methods and analysisUse of smartphone-based digital stewardship applications (apps) with local guideline directed empirical antimicrobial use by physicians will be compared with antimicrobial prescription as per usual as primary outcome in three hospitals in the Netherlands, Sweden and Switzerland. Secondary outcomes will include antimicrobial use metrics, clinical and process outcomes. A multicentre stepped-wedge cluster randomised trial will randomise entities defined as wards or specialty regarding time of introduction of the intervention. We will include 36 hospital entities with seven measurement periods in which the primary outcome will be measured in 15 participating patients per time period per cluster. At participating wards, patients of at least 18 years of age using antimicrobials will be included. After a baseline period of 2-week measurements, six periods of 4 weeks will follow in which the intervention is introduced in 6 wards (in three hospitals) until all 36 wards have implemented the intervention. Thereafter, we allow use of the app by everyone, and evaluate the sustainability of the app use 6 months later.Ethics and disseminationThis protocol has been approved by the institutional review board of each participating centre. Results will be disseminated via media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications.Trial registration numberClinicalTrials.gov registry (NCT03793946). Stage; pre-results.

revision of antimicrobial therapies and surveillance of antibiotic consumption. Purpose The aim of the study was to analyse antibiotic use and microbiological data in the ward between 2010 and 2017. Material and methods Data was collected on systemic antibiotics dispensed from the pharmacy's database. Both WHO defined daily dose (DDD) and prescribed daily dose (PDD) methods were used to analyse the antibiotic consumption, standardised to 100 patient days. PDDs were defined according to therapeutic guidelines and revised by infectologists. Microbiological data were collected from the Microbiology Department's database. Results The cost of antibiotics accounts for 65% of all pharmaceutical expenses between 2010 and 2017. Twenty-eight antibacterial agents were used in 2017, 30 in 2013 and 2010. In 2017, 11 agents were responsible for the DU90% segment of the consumption. Most extensively used agents were amoxicillin-clavulanic-acid, cefuroxime and ciprofloxacin. There was a significant difference between the results of DDD-PDD analyses. The utilisation of clindamycin (14.48 DDD/100 patient days in 2013 vs. 2.99 in 2017the same in PDDs) and ceftriaxone (3.61 vs. 0.31 DDD/100 patient daysthe same in PDDs) decreased notably, while the use of narrow-spectrum beta-lactams increased in the past 3 years (from 2.93 to 7.84 DDD/100 patient days -1.12 vs. 4.13 PDD/100 patient days), which was an initial goal of the pharmacists' interventions. Microbiological data showed an increased rate of multiresistant pathogens, especially Vancomycin-resistant E. faecium (0 in 2010, two in 2013 and 14 in 2017), resulting in increased consumption of reserve antibiotics such as linezolid (no use until 2015, 0.23 DDD/100 patient days in 2017) and tigecycline (no use until 2013, 0.28 DDD/100 patient days in 2017). Conclusion Monitoring the use of antibiotics and comparing results with microbiological data provides a range of local resistance conditions, which are fundamental to antimicrobial guideline development. The data highlights desirable trends and critical points, allowing pharmacists to feedback to prescribers and emphasise the value of their interventions. Interpretation of results must account for the fact that the generally accepted DDD method can be incorrect due to differences in antibiotic dosing.