title: Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital.
abstract: BACKGROUND
  The optimal way for antimicrobial stewardship programs (ASPs) to interact with existing infectious disease physician (IDP) services within the same institution is unknown. In our institution, IDPs and our prospective audit and feedback ASP operate independently, with occasionally differing recommendations offered for the same inpatient. We performed a retrospective audit on inpatients that had been reviewed by both IDPs and ASP within a 7-day period, focusing on cases where different therapy-modifying recommendations had been offered. We analyzed the outcomes in inpatients where the ASP recommendations were accepted and compared these with the inpatients where the IDP recommendations were accepted instead. Outcomes assessed were 30-day mortality post-ASP review, unplanned re-admission within 30 days post-discharge from hospital, and clinical deterioration at 7 days post-ASP review.
  
  
  RESULTS
  There were 143 (18.9%) patients where differing recommendations had been offered, with primary physicians accepting 69.9% of ASP recommendations. No significant differences in terms of demographics, clinical characteristics, 30-day mortality, and re-admission rates were observed, although clinical deterioration rates were lower in patients where the ASP recommendation was accepted (8.0% vs. 27.9%; p = 0.002). On multivariate analysis, hematology-oncology inpatients were associated with unplanned readmission. Increasing age and hematology-oncology inpatients were associated with clinical deterioration 7 days post-recommendation, whereas acceptance of ASP recommendations was protective. No characteristic was independently associated with 30-day mortality.
  
  
  CONCLUSIONS
  In conclusion, independent reviews by both IDPs and ASPs can be compatible within large tertiary hospitals, providing primary physicians even in situations of conflicting recommendations viable alternative antimicrobial prescribing advice.
authors.forename: Chay Leng
authors.initials: CL
authors.lastname: Yeo
authors.forename: Jia En
authors.initials: JE
authors.lastname: Wu
authors.forename: Gladys Wei-Teng
authors.initials: GW
authors.lastname: Chung
authors.forename: Douglas Su-Gin
authors.initials: DS
authors.lastname: Chan
authors.forename: Hui Hiong
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Department of Medicine, National University Health System, NUHS Tower Block Level 10, 1E Kent Ridge Road, Singapore 119228, Singapore. liyang_hsu@yahoo.com.
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu