title: Sustained impact of a computer-assisted antimicrobial stewardship intervention on antimicrobial use and length of stay.
abstract: : Prospective audit and feedback interventions are the core components of an antimicrobial stewardship programme. Herein, we describe the sustained impact of an antimicrobial stewardship programme, based on a novel clinical decision-support system (Antimicrobial Prescription Surveillance System; APSS), on antimicrobial use and costs, hospital length of stay (LOS) in days and the proportion of inappropriate antimicrobial prescriptions.
  
  
  
  A quasi-experimental, retrospective study was conducted using interrupted time series between 2008 and 2013. Data on all hospitalized adults receiving antimicrobials were extracted from the data warehouse of a 677 bed academic centre. The intervention started in August 2010. Prospective audit and feedback interventions, led by a pharmacist, were triggered by APSS based on deviations from published and local guidelines. Changes in outcomes before and after the intervention were compared using segmented regression analysis.
  
  
  
  APSS reviewed 40 605 hospitalizations for 35 778 patients who received antimicrobials. The intervention was associated with a decrease in the average LOS (level change -0.92, P  < 0.01; trend -0.08, P  < 0.01; intercept 11.4 days), antimicrobial consumption in DDDs/1000 inpatient days (level change -32.4, P  < 0.01; trend -1.12, P  <   0.02; intercept 243 DDDs per 1000 days of hospitalization), antimicrobial spending in Canadian dollars (level change -19 649, P  = 0.01; trend -1881, P  < 0.01; intercept $74 683) and proportion of non-concordance with local guidelines for prescribing antimicrobials (level change -2.3, P  = 0.04; intercept 41%).
  
  
  
  The implementation of the APSS-initiated strategy was associated with a positive impact on antimicrobial use and spending, LOS and inappropriate prescriptions. The high rate of accepted interventions may have contributed to these results.
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Nault
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pepin
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Beaudoin
authors.affiliation: Department of Pharmacy, Centre Intégré Universitaire de Santé et des Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Perron
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Moutquin
authors.affiliation: Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Valiquette
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D065186:Interrupted Time Series Analysis; D007902:Length of Stay; D008297:Male; D010595:Pharmacists / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents