Prospective audit for antimicrobial stewardship in intensive care: Impact on resistance and clinical outcomes

Background: The impact of antimicrobial audit and feedback on outcomes of critically ill adults is unclear. Methods: A prospective study was performed in the intensive care units (ICU) of a public hospital in Atlanta, GA. Critically ill adults receiving empiric imipenem or piperacillin-tazobactam were eligible. Outcomes for 3 periods were compared: baseline (B, February to May 2006), model 1 (M1, October 2006 to July 2008), and model 2 (M2, September 2008 to February 2009). No audit was performed during B. During M1, an infectious diseases physician evaluated patients, and a critical care pharmacist communicated recommendations to the treating team. During M2, an infectious diseases physician directly participated in interdisciplinary rounds with the medical ICU team. Results: One hundred ninety-four patients were included during B, 415 during M1, and 83 during M2. M1 and M2 were associated with appropriate antimicrobial selection (B, 70%; M1, 78%; M2, 82%; P=.042) and with lower rates of resistance (B, 31%; M1, 25%; M2, 17%; P=.033). Logistic regression analysis confirmed that audit and feedback were independently associated with appropriate antimicrobial selection and prevention of resistance. The association remained strongest for M2. Conclusion: Audit and feedback had an influence on antimicrobial prescription patterns in the ICU with a favorable impact on the emergence of resistance. Copyright ( C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.