Antimicrobial use metrics and benchmarking to improve stewardship outcomes: methodology, opportunities, and challenges

Infect Dis Clin North Am. 2014 Jun;28(2):195-214. doi: 10.1016/j.idc.2014.01.006.


Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is days of therapy/1000 patient-days. Clinical outcomes, including response to therapy and bacterial resistance, are critical measures but are more difficult to document than economic outcomes. Interhospital benchmarking of risk adjusted antimicrobial use is possible, although several obstacles remain before it can have an impact on patient care. Many challenges for stewardship programs remain, but the methods and science to support their efforts are rapidly evolving.

Keywords: Antibiotic epidemiology; Antibiotic metrics; Antibiotic resistance; Antibiotic stewardship; Antibiotic use; Benchmarking.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Benchmarking / methods*
  • Delivery of Health Care / standards*
  • Drug Resistance, Bacterial
  • Drug Utilization Review / methods*
  • Hospitals
  • Humans
  • Metric System


  • Anti-Bacterial Agents