title: Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: a multicenter intervention.
abstract: OBJECTIVE
  To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use.
  
  
  METHODS
  Quasi-experimental before-after study.
  
  
  METHODS
  Five academic medical centers.
  
  
  METHODS
  Adults receiving at least 48 hours of study-ABX.
  
  
  METHODS
  The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study-ABX per 1,000 study-patient-days in the baseline and intervention periods.
  
  
  RESULTS
  There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97; P = .002) at hospital B and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P < .001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses.
  
  
  CONCLUSIONS
  Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. scosgro1@jhmi.edu
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.forename: Susan K
authors.initials: SK
authors.lastname: Seo
authors.forename: Maureen K
authors.initials: MK
authors.lastname: Bolon
authors.forename: Kent A
authors.initials: KA
authors.lastname: Sepkowitz
authors.forename: Michael W
authors.initials: MW
authors.lastname: Climo
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.forename: Kathleen
authors.initials: K
authors.lastname: Speck
authors.forename: Vidhya
authors.initials: V
authors.lastname: Gunaseelan
authors.forename: Gary A
authors.initials: GA
authors.lastname: Noskin
authors.forename: Loreen A
authors.initials: LA
authors.lastname: Herwaldt
authors.forename: Edward
authors.initials: E
authors.lastname: Wong
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D017723:Drug Utilization Review / Q000379:methods*; D005246:Feedback; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D055553:Prescription Drugs / Q000627:therapeutic use; D015397:Program Evaluation; D014481:United States
chemical_list: D000890:Anti-Infective Agents; D055553:Prescription Drugs