Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines

Table 1 Results of the ASP audit on recommendations and outcomes over 3 years (August 2009 to July 2012)

	Year 1	Year 2	Year 3
	(August 2009 to July 2010)	(August 2010 to July 2011)	(August 2011 to July 2012)
Number of prescriptions reviewed	1,414	1,168	1,567
Number of antimicrobial stewardship recommendations made (percentage of prescriptions reviewed)	649 (45.9%)	363 (31.1%)^b	557 (35.5%)
• Discontinuation of antibiotic therapy	239	135	227
• De-escalation of antibiotic therapy	198	74	176
• Intravenous to enteral switch	49	10	47
• Escalation of antibiotic therapy	25	7	13
• Antibiotic dosing	39	68	49
• Others^a	99	69	45
Recommendation acceptance (percentage of recommendations accepted)	570 (87.7%)	266 (73.3%)^b	464 (83.3%)
Antimicrobial prescription (defined daily dose/1,000 inpatient-days)
• All intravenous antibiotics	468.6	580.3^c	513.7
• All carbapenems	130.8	181.2^c	149.1
• 3^rd and 4^th-generation cephalosporins	128.2	95.1^d	108.7
• Piperacillin/tazobactam	62.2	116.0^c	160.8
• Vancomycin	80.9	108.7^e	38.1

^a”Others” include advice on duration of antibiotics, further investigations, and advice on referral to infectious diseases specialists.
^bStatistically significant difference between Years 1 and 2, and Years 2 and 3, based on the chi-square test.
^cStatistically significant difference between Years 1 and 2, and Years 2 and 3, based on Wilcoxon rank-sum test.
^dStatistically significant difference between Years 1 and 2 only, based on the Wilcoxon rank-sum test.
^eStatistically significant difference between Years 2 and 3 only, based on the Wilcoxon rank-sum test.

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