Understanding inpatient antimicrobial stewardship metrics

ASPs are important tools in helping to maintain our current antimicrobial armamentarium. This fact has become more apparent in recent years with the emergence of regulatory requirements that will need to be satisfied to demonstrate that a healthcare facility has an active ASP. However, the best metrics to demonstrate ASP effectiveness are still being determined. DOT is the most widely accepted ASP metric in the United States. While newer metrics such as the SAAR can help an institution benchmark its antimicrobial use with that of other institutions, such metrics still do not tell us how appropriately antimicrobials are used in an acute healthcare facility. Improved reporting in the AUR module will increase CDC's ability to determine areas of future opportunity and assist with national benchmarking. Directly correlating definite outcomes such as mortality, adverse events, and other endpoints to ASP efforts is challenging. Similarly, defining metrics such as antimicrobial appropriateness might provide a much-desired measure for ASPs, but complexities in defining appropriateness limit current capabilities in ASP research. For this reason, more work is needed to identify the set of process and outcome measures that demonstrate that an ASP is functioning efficiently and helping in the care of our patients.