Maximizing resources in stewardship: Look at the quartiles

Reviewed by Jose Lucar, MD, The George Washington University

In this retrospective cohort study conducted in four Canadian adult medicine wards between 2010-2019, the authors aimed to measure physician-level antimicrobial prescribing, assess the role of patient-level factors to antimicrobial prescribing, and evaluate the association between antimicrobial prescribing and clinical outcomes. The authors stratified physicians into quartiles by hospital based on volume of antimicrobial prescribing (DOT per 100 patient-days) and spectrum (a modified spectrum score). They found a 30% difference in antimicrobial prescribing volume between the highest and lowest quartiles (difference of 15.8 DOT/100 PD , 95% CI 9.6–22.0), with no association between the prescribing quartile and patient-level characteristics or clinical outcomes. However, the in-hospital mortality was higher among patients managed by physicians with higher modified spectrum scores (OR 1.13, 95% CI 1.04–1.24). These findings indicate that measuring physician-level antimicrobial prescribing and identifying the higher-volume prescribers could represent a meaningful target for antimicrobial stewardship interventions while maximizing limited resources.

CMAJ 2023 August 21;195:E1065-74

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