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

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

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Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32611, USA.
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia Campus, 410 North 12th Street, Richmond, VA 23298, USA. Electronic address:


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.


Antibiotic epidemiology; Antibiotic metrics; Antibiotic resistance; Antibiotic stewardship; Antibiotic use; Benchmarking

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