Table 4: Frequency of implementation of antimicrobial stewardship strategies.
| Strategy | No. (%) of hospitals | ||||
|---|---|---|---|---|---|
| Acute teaching n = 15 |
Large community n = 44 |
Small community n = 27 |
Complex continuing care/inpatient rehabilitation n = 11 |
Overall n = 97 |
|
| Prescribing guidance | |||||
| Intravenous to oral conversion | 11 (73) | 36 (82) | 17 (63) | 5 (45) | 69 (71) |
| Disease-specific treatment guidelines/pathways/algorithms and/or associated order forms | 10 (67) | 36 (82) | 15 (56) | 8 (73) | 69 (71) |
| Empiric antibiotic prescribing guidelines | 12 (80) | 29 (66) | 13 (48) | 7 (64) | 61 (63) |
| Prescriber education | 13 (87) | 30 (68) | 9 (33) | 5 (45) | 57 (59) |
| Facilitation of appropriate and timely antimicrobial administration in severe sepsis/septic shock | 7 (47) | 24 (54) | 9 (33) | 1 (9) | 41 (42) |
| Clinical decision support systems/computerized physician order entry | 5 (33) | 4 (9) | 2 (7) | 1 (9) | 12 (12) |
| Clinical | |||||
| Therapeutic drug monitoring (with feedback) | 12 (80) | 39 (89) | 23 (85) | 9 (82) | 83 (86) |
| Dosage optimization | 12 (80) | 37 (84) | 17 (63) | 6 (54) | 72 (74) |
| Deescalation and streamlining | 11 (73) | 31 (70) | 16 (59) | 5 (45) | 63 (65) |
| Prospective audit with intervention and feedback | 12 (80) | 36 (82) | 9 (33) | 6 (54) | 63 (65) |
| Targeted review of redundant therapy or therapeutic duplication | 5 (33) | 31 (70) | 18 (67) | 4 (36) | 58 (60) |
| Identification of inappropriate pathogen/antimicrobial combinations ("bug-drug mismatch") | 7 (47) | 30 (68) | 14 (52) | 7 (64) | 58 (60) |
| Targeted review of patients with Clostridium difficile infection | 5 (33) | 34 (77) | 11 (41) | 6 (54) | 56 (58) |
| Preventing treatment of noninfectious conditions | 6 (40) | 26 (59) | 7 (26) | 3 (27) | 42 (43) |
| Targeted review of patients with bacteremia/fungemia | 7 (47) | 24 (54) | 7 (26) | 2 (18) | 40 (41) |
| Scheduled antimicrobial reassessments ("antibiotic time outs") | 4 (27) | 16 (36) | 7 (26) | 2 (18) | 29 (30) |
| Microbiology-related | |||||
| Antibiograms | 14 (93) | 41 (93) | 19 (70) | 5 (45) | 79 (81) |
| Reporting of cascading microbiology susceptibility | 12 (80) | 35 (80) | 4 (15) | 2 (18) | 53 (55) |
| Reporting of strategic microbiology results | 12 (80) | 31 (70) | 7 (26) | 3 (27) | 53 (55) |
| Promotion of timely and appropriate microbiologic sampling | 10 (67) | 27 (61) | 12 (44) | 2 (18) | 51 (52) |
| Improved diagnostics | 12 (80) | 25 (57) | 8 (30) | 2 (18) | 47 (48) |
| Structural/process-related | |||||
| Automatic stop orders | 8 (53) | 39 (89) | 24 (89) | 7 (64) | 78 (80) |
| Drug use evaluation/medication use evaluation | 9 (60) | 23 (52) | 11 (41) | 7 (64) | 50 (52) |
| Optimization of surgical antibiotic prophylaxis | 13 (87) | 27 (61) | 5 (18) | 1 (9) | 46 (47) |
| General antimicrobial order forms | 1 (7) | 14 (32) | 8 (30) | 4 (36) | 27 (28) |
| Systematic antibiotic allergy verification | 1 (7) | 15 (34) | 3 (11) | 6 (54) | 25 (26) |
| Improved antimicrobial documentation | 2 (13) | 10 (23) | 6 (22) | 4 (36) | 22 (23) |
| Checklists | 4 (27) | 5 (11) | 1 (4) | 4 (36) | 14 (14) |
| Formulary-related | |||||
| Formulary review/streamlining | 10 (67) | 35 (80) | 23 (85) | 5 (45) | 73 (75) |
| Formulary automatic substitution/therapeutic interchange policies | 10 (67) | 37 (84) | 18 (67) | 4 (36) | 69 (71) |
| Formulary restriction | 11 (73) | 26 (59) | 11 (41) | 4 (36) | 52 (54) |
| Formulary restriction with preauthorization | 6 (40) | 15 (34) | 4 (15) | 3 (27) | 28 (29) |