Prospective audit and feedback in antimicrobial stewardship: Is there value in early reviewing within 48 h of antibiotic prescription?

• Most antimicrobial stewardship programmes (ASPs) wait ≥72 h post antibiotic prescription before reviewing patients.
• We evaluated the impact of reviewing patients within 48 h of antibiotic prescription on patient outcomes and safety.
• ASP interventions were associated with decreased duration of therapy without increasing length of hospital stay, re-admissions and Clostridium difficile infection rate.
• This was evident even during empirical therapy when not all clinical information was available.

Antimicrobial stewardship programme (ASP) methodologies are not well defined, with most preferring to wait ≥72–96 h following antibiotic prescription before reviewing patients. However, we hypothesise that early ASP reviews and interventions are beneficial and do not adversely impact patient safety. This study aimed to evaluate the impact of early ASP interventions within 48 h of antibiotic prescription on patient outcomes and safety. A prospective review of ASP interventions made within 48 h of antibiotic prescription in Singapore General Hospital (SGH) from January to December 2012 was conducted. Patient demographics and outcomes were extracted from the database maintained by the ASP team. For culture-directed treatment, there was a shorter mean duration of therapy (DOT) in the accepted group compared with the rejected group (2.26 days vs. 5.56 days; P < 0.001). ASP interventions did not alter the length of hospital stay (LOS), 30-day mortality, 14-day Clostridium difficile infection (CDI), 30-day re-admissions and 14-day re-infection (all P > 0.05). For empirical treatment, a shorter DOT (3.61 days vs. 6.25 days; P < 0.001) and decreased 30-day all-cause mortality (P = 0.003) and infection-related mortality (P = 0.002) were observed among patients in the accepted group compared with the rejected group. There was no significant difference in LOS, 14-day CDI and 30-day re-admission (all P > 0.05). In conclusion, acceptance of early interventions recommended by ASP in SGH was associated with a reduction in DOT without compromising patient safety. This is evident even during empirical therapy when not all clinical information was available.