Longitudinal evaluation of a World Wide Web-based antimicrobial stewardship program: assessing factors associated with approval patterns and trends over time.
BACKGROUND
The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP.


METHODS
We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval.


RESULTS
The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P < .01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent.


CONCLUSIONS
The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Vidya
V
Venugopal
Department of Pediatrics and Biomedical Informatics, Vanderbilt University, Nashville, TN.
Christoph U
CU
Lehmann
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Marie
M
Diener-West
Department of Pediatric and Adult Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ageorg10@jhmi.edu.
Allison L
AL
Agwu
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D020407:Internet / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male
D000900:Anti-Bacterial Agents
Antibiotic requests; Approvals; Outcomes