Essential Resources and Strategies for Antibiotic Stewardship Programs in the Acute Care Setting.

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Clinical infectious diseases : an official publication of the Infectious Diseases Society of America


Background: Antibiotic stewardship programs improve clinical outcomes and patient safety and help combat antibiotic resistance. Specific guidance on resources needed to structure stewardship programs is lacking. This manuscript describes results of a survey of U.S. stewardship programs and resultant recommendations regarding potential staffing structures in the acute care setting.

Methods: A cross-sectional survey of members of three infectious diseases subspecialty societies actively involved in antibiotic stewardship was conducted. Survey responses were analyzed with descriptive statistics. Logistic regression models were used to investigate the relationship between stewardship program staffing levels and self-reported effectiveness and to determine which strategies mediate effectiveness.

Results: Two-hundred and forty-four respondents from a variety of acute care settings completed the survey. Prior authorization for select antibiotics, antibiotic reviews with prospective audit and feedback, and guideline development were common strategies. Eighty-five percent of surveyed programs demonstrated effectiveness in at least one outcome in the prior two years. Each 0.50 increase in pharmacist and physician full-time equivalent support predicted a 1.48-fold increase in the odds of demonstrating effectiveness. The effect was mediated by the ability to perform prospective audit and feedback. Most programs noted significant barriers to success.

Conclusions: Based on our survey's results, we propose a full-time equivalent to bed ratio that can be used as a starting point to guide discussions regarding necessary resources for antibiotic stewardship programs with executive leadership. Prospective audit and feedback should be the cornerstone of stewardship programs, and both physician leadership and pharmacists with expertise in stewardship are crucial for success.


Infectious Diseases