Positive effects of audit and feedback on antimicrobial use in hospitalized patients limited to audited patients

Elske M Engel-Dettmers; Nashwan Al Naiemi; Hero E Dijkema; Annemarie L M A Braakman-Jansen; Lisette J E W C van Gemert-Pijnen; Bhanu Sinha

doi:10.1017/ash.2024.37

Positive effects of audit and feedback on antimicrobial use in hospitalized patients limited to audited patients

Antimicrob Steward Healthc Epidemiol. 2024 Apr 16;4(1):e46. doi: 10.1017/ash.2024.37. eCollection 2024.

Authors

Elske M Engel-Dettmers^{1

2}, Nashwan Al Naiemi³, Hero E Dijkema⁴, Annemarie L M A Braakman-Jansen¹, Lisette J E W C van Gemert-Pijnen¹, Bhanu Sinha⁵

Affiliations

¹ Faculty of Behavioral, Management and Social Sciences, Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
² Department of Clinical Pharmacy, ZGT, Almelo and Hengelo, The Netherlands.
³ Department of Medical Microbiology, Labmicta, Hengelo, The Netherlands.
⁴ Department of Urology, ZGT, Almelo and Hengelo, The Netherlands.
⁵ Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Objective: Audit and feedback is an antimicrobial stewardship (AMS) strategy, with the potential to also optimize antimicrobial use in non-audited patients. This study aimed to determine whether audit and feedback reduce antimicrobial use in both audited and non-audited patients.

Design: Before-after trial with a 1-year intervention period and 2.5-year historical cohort.

Setting: 750-bed community hospital in the Netherlands.

Patients: All patients admitted to the urology wards during the 3.5-year study period were observed. Patients were classified as using antimicrobials if any antimicrobial was used for therapeutic reasons. Patients using antimicrobials prophylactically were excluded from measurements.

Intervention: The AMS team provided audit and feedback on antimicrobial use for patients using antimicrobials for 2 days. Retrospectively, antimicrobial use and length of stay (LOS) were compared with the historical cohort.

Results: Audits modified antimicrobial treatment in 52.8% of the cases. De-escalating, stopping, and switching from intravenous to oral treatment accounted for 72% of these modifications. Compared to patients from the cohort, who also used antimicrobials for 2 days, antimicrobial use decreased from 14.21 DDD/patient (95% CI, 13.08-15.34) to 11.45 DDD/patient (95% CI, 8.26-14.64; P = .047) for audited patients. Furthermore, mean LOS decreased from 7.42 days (95% CI, 6.79-8.06) to 6.13 days (95% CI, 5.38-6.89; P = .031). However, looking at all patients admitted to the urology wards, the percentage of patients using antimicrobials and total antimicrobial use remained unchanged.

Conclusions: Audit and feedback reduce antimicrobial use and LOS, but only for audited patients. Positive effects are not automatically transferred to patients for whom no audits have been performed.