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

Am J Infect Control. 2012 Aug;40(6):526-9. doi: 10.1016/j.ajic.2011.07.011. Epub 2011 Sep 21.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Bacterial Infections / drug therapy*
  • Critical Care / methods
  • Critical Illness
  • Drug Prescriptions / standards*
  • Drug Utilization / standards*
  • Female
  • Georgia
  • Health Services Research*
  • Hospitals
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Prospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents