Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings

Clin Infect Dis. 2017 Feb 1;64(3):377-383. doi: 10.1093/cid/ciw787. Epub 2016 Dec 7.


Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development.

Keywords: antimicrobial stewardship; outcome measure; patient safety; process measure; quality metrics..

Publication types

  • Consensus Development Conference

MeSH terms

  • Anti-Infective Agents / therapeutic use*
  • Clostridioides difficile
  • Communicable Diseases / drug therapy*
  • Communicable Diseases / epidemiology*
  • Drug Prescriptions / standards*
  • Drug Resistance, Bacterial*
  • Enterocolitis, Pseudomembranous / drug therapy
  • Enterocolitis, Pseudomembranous / epidemiology
  • Humans
  • Incidence
  • Patient Admission
  • Patient Care / standards*
  • Patient Safety
  • Program Evaluation / methods*
  • Treatment Outcome
  • United States


  • Anti-Infective Agents