Improving Antimicrobial Stewardship Programs: a National Survey of the IDSA Emerging Infections Network

Background: Antimicrobial stewardship programs (ASPs) promote optimal antimicrobial prescribing to improve patient safety/outcomes and to prevent development of antimicrobial resistance. In 2007, a guideline for developing ASPs was developed by IDSA and SHEA. The extent to which this guideline has been implemented is unknown, as are strategies that could improve the effectiveness of these programs.

Objective: To determine how common inpatient ASPs are, and how they can be improved.

Methods: In September 2009, we surveyed 1044 members of the EIN, a North American network of ID consultants. Participants, all with adult practices, responded regarding whether their hospital had or planned to develop an ASP, its characteristics, barriers to an effective ASP, and data to improve program effectiveness.

Results: 522 physicians responded (50%). 61% of respondents reported that their institutions had an ASP; an additional 12% reported plans to start one. Type of hospital was significantly associated with whether an ASP was present: 79% of respondents from university hospitals, 65% from non-university teaching hospitals, 64% from VA/military hospitals, 57% from city/county hospitals, and 40% from community hospitals reported ASPs (p<.0001). Respondents reporting no ASP were significantly more likely to work in private practice in the East North Central region and in a community hospital with fewer than 200 beds. Lack of funding or personnel was reported as the primary barrier to an effective ASP, and 83% indicated that outcomes data showing a decrease in costs would be the most effective way to convince administrators to support ASPs. Conversely, members felt that the most effective outcomes data to convince clinicians to use ASP recommendations would be: reduced C. difficile infections (by 65%), reduced adverse drug events associated with inpatient antibiotics (by 67%), and a reduction in antimicrobial resistance (by 73%). Management support was reported as very high or good by 52% (by 44% from community hospitals and 58% from university hospitals).

Conclusions: Almost three-quarters of respondents reported having or planning to have an ASP. Funding issues were reported as the primary barrier to having ASPs by all respondents regardless of whether their institution had an ASP. Data associating ASPs with a decrease in costs were felt by almost all respondents to be most important in convincing administrators to support ASPs. Efforts to increase the adoption of ASPs and to enhance the extent to which recommendations are implemented require demonstration of both economic and clinical benefits.