Disclosures: Suda reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
March 18, 2021
2 min read

Q&A: Quality improvement program ‘removed barriers’ to antibiotic stewardship in hospitals

Disclosures: Suda reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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A quality improvement program reduced antibiotic use and strengthened antimicrobial stewardship in hospitals, according to an analysis published in JAMA Network Open.

Pranita D. Tamma, MD, MHS, associate professor of pediatrics and director of the pediatric antimicrobial stewardship program at Johns Hopkins Medicine, and colleagues evaluated the effectiveness of the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use in 402 U.S. hospitals.

Katie Suda quote

The researchers found that adherence to antibiotic stewardship programs — defined as interventions before and after antibiotic prescription, the availability of antibiotic guidelines, stewardship program leads with salary support and antibiotic quarterly reporting — increased from 8% to 75% over a period of 1 year (P < .01). The use of antibiotics also decreased by 30.3 days of antibiotic therapy per 1,000 patient-days (95% CI, –52.6 to –8 days of antibiotic therapy). The rate of hospital-onset Clostridiodes difficile also decreased by 19.55% during the 1-year study period (95% CI, –33.5% to –2.4%).

“Use of Safety Program resources provides opportunities for hospitals across the United States seeking to improve antibiotic use by establishing or strengthening existing antibiotic stewardship programs and teaching frontline clinicians to become self-stewards of their antibiotic use,” Tamma and colleagues wrote.

In an accompanying editorial, Katie J. Suda, PharmD, MS, FCCP, professor of medicine at the University of Pittsburgh School of Medicine, and colleagues wrote that to improve the implementation of antimicrobial stewardship strategies, “future work should focus on implementation strategies that support widespread uptake of interventions and ensure sustainability.”

Healio spoke with Suda about the relationship between antimicrobial stewardship and quality improvement projects like the one described by Tamma and colleagues.

Healio: What role does quality improvement have, broadly speaking, in improving antimicrobial stewardship?

Suda: The ultimate goal of quality improvement and antimicrobial stewardship are to improve patient safety by identifying what needs to be improved, implementing strategies to improve antibiotic prescribing, focusing on feasible and high-impact interventions and measuring program outcomes. The long-term goals of antimicrobial stewardship are to decrease the development of C. difficile infection and antimicrobial resistance.

Healio: Are there lessons from the pandemic that clinicians can apply to quality improvement?

Suda: We have learned that we all have essential roles in taking care of our patients and need to work together to provide optimal care. Quality improvement can and should be done to rapidly implement evidence in clinical care. However, we need to critically evaluate the evidence and ensure rigorous study design and accurate reporting of the results, especially for manuscripts published prior to peer review.

Healio: What barriers to improving antimicrobial stewardship practices do clinicians currently face?

Suda: There are several publications detailing the barriers and facilitators to antibiotic prescribing and implementing antimicrobial stewardship practices. What is so unique about the study by Tamma and colleagues is that the program worked in well-resourced hospitals (such as large academic facilities) and low-resourced hospitals (such as smaller community hospitals and critical access hospitals). Almost half of the participating hospitals did not have infectious diseases specialists. Through basic implementation strategies, the program removed barriers to implementing antimicrobial stewardship.

Healio: How can quality improvement departments help address those barriers?

Suda: Most hospitals have entire departments focused on quality improvement. These departments have information technology, data scientists and improvement specialists. Most antimicrobial stewards do not have these skills, and few hospitals provide personnel with this expertise to the antimicrobial stewardship program. Thus, quality improvement departments are needed to understand and implement interventions and evaluate the impact of the antimicrobial stewardship program on patient care.


McGregor JC, et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2021.1072.

Tamma PD, et al. JAMA Netw Open. 2020;doi: 10.1001/jamanetworkopen.2021.0235.