An education-based antimicrobial stewardship strategy to reduce prescribing inappropriateness

Abstract Issue Antimicrobial resistance is a crucial issue in public health, mainly induced from an inappropriate prescription of antibiotic drugs. Antimicrobial stewardship strategies can be used to tackle the problem; a iso-resources, audit- and feedback-based, antimicrobial stewardship intervention with educational feedback was performed in the Local Health Unit TO3. Description of the problem From December 2022 to November 2024, stewardship interventions are being implemented in the 3 facilities of the local health unit. Prescribing inappropriateness (main outcome), department's specialty, interhospital variability, number of antibiotics prescription and cultural examination were assessed over time. A mixed method evaluation was conducted. Logistical analysis was performed with R. Stratified analysis between empirical and cultural based targeted therapy was assessed. A qualitative analysis of the causes was performed via interview. Results A total of 1020 clinical records were analyzed. Inappropriateness varied from 27% at the beginning of the intervention to 8% at the end. Associated factors with inappropriateness were the length of intervention (OR: 0.86; IC: 0.78-0.95), department's specialty (OR: 1.66; IC: 1.18-2.32) and number of prescriptions (OR: 2.07; IC: 1.58-2.70). Empirical therapy (n = 598) showed higher range of variation pre-post intervention and similar outcomes at multivariable analysis. Targeted therapy (n = 291) showed no impact of the intervention over time. Specific types of antibiotics seemed at major risk of prescribing inappropriateness (carbapenems and quinolones). Findings from the qualitative analysis suggest that a peer-based motivational intervention could be useful and that the internal setup of the departments influences the prescribing appropriateness. Lessons An iso-resources education-based stewardship intervention is useful for ameliorating prescribing appropriateness. Specific kind of intervention need to be addressed in future studies. Key messages • A back-end antimicrobial stewardship strategy based on educational and peer approach could be effective even if iso-resources. • Understanding the specific determinants of prescription habits is crucial for implementing tailored antimicrobial stewardship interventions.