Audit and Feedback to Reduce Broad-Spectrum Antibiotic Use among Intensive Care Unit Patients A Controlled Interrupted Time Series Analysis

Abstract

Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care.

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

“…In addition, the development of new antimicrobial agents has slowed, 6 leaving clinicians with few options to treat antibioticresistant infections, which are associated with increases in length of stay, mortality, and cost. 7 Evidence from a recent systematic review, 8 a controlled interrupted time series analysis of antimicrobial stewardship in critical care, 9 and a randomized study with stepped wedge design involving ward patients at Sunnybrook Health Sciences Centre, Toronto, Ontario, 10 has shown that antimicrobial stewardship programs were associated with reductions in antibiotic use, costs, adverse events, and antimicrobial resistance without compromising clinical outcomes such as nosocomial infection rates, length of stay, or mortality rates among critically ill and ward patients in acute care settings.…”

Prospective Audit and Feedback of Antimicrobial Stewardship in Critical Care: Program Implementation, Experience, and Challenges

“…The infectious diseases physicians played a pivotal role in obtaining this support through their preliminary discussion with critical care staff (before initiation of the "Day 3 Reflections" program) and their involvement with each patient for whom a change in antimicrobial therapy was recommended. As a result, the program has been associated with substantial decreases in the use of broad-spectrum antibiotics and in the incidence of Clostridium difficile infections (details to be published elsewhere 5 ). Major barriers to the implementation of an antimicrobial stewardship program that have been reported in the literature include opposition from prescribers and potential antagonism of other practitioners.…”

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

“…32 A previous audit and feedback pilot study of antimicrobial stewardship in the critical care setting demonstrated that a formal, prospective audit and feedback program led to more appropriate use of broad-spectrum antimicrobial agents and illustrated that pharmacists can play a pivotal role in promoting appropriate antimicrobial utilization. 32,33 Goal 3, objective 3.9 of the Canadian Society of Hospital Pharmacy 2015 initiative-"…pharmacists will be actively involved in medication-and vaccination-related infection control programs"-further supports the proposition that pharmacists should actively apply evidence-based methods to the improvement of antimicrobial treatment.…”