title: An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage.
abstract: OBJECTIVE
  To determine whether an antimicrobial stewardship 'intensity' score predicts hospital antimicrobial usage.
  
  
  METHODS
  An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy programmes, de-escalation of therapy, antimicrobial order forms and dose optimization). Multiple regression analyses were used to assess whether the composite score and also the categories were associated with either total or antimicrobial stewardship programme-target antimicrobial use as measured in days of therapy.
  
  
  RESULTS
  The mean antimicrobial stewardship programme score was 55 (SD 21); the total composite score was not significantly associated with total or target antimicrobial use [estimate -0.49 (95% CI -2.30 to 0.89)], while the category strategies was significantly and negatively associated with target antimicrobial use [-5.91 (95% CI -9.51 to -2.31)].
  
  
  CONCLUSIONS
  The strategy component of a score developed to measure the intensity of antimicrobial stewardship was associated with the amount of antimicrobials used. Thus, the number and types of strategies employed by antimicrobial stewardship programmes may be of particular importance in programme effectiveness.
authors.affiliation: Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA apakyz@vcu.edu.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Pakyz
authors.affiliation: Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Leticia R
authors.initials: LR
authors.lastname: Moczygemba
authors.affiliation: Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stevens
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000458:organization & administration; D004363:Drug Utilization / Q000592:standards*; D006291:Health Policy; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
keywords: audit with intervention and feedback; automated surveillance software; preauthorization