# P-965. Effectiveness of Augmented Prospective Audit and Feedback in Reducing Carbapenem Use Following Discontinuation of Preauthorization

## TL;DR

An enhanced audit and feedback strategy helped reduce carbapenem use in a hospital after antimicrobial stewardship preauthorization was suspended.

## Contribution

The study demonstrates that augmenting audit and feedback with clinical rounds and real-time feedback improves prescriber adherence and reduces carbapenem use.

## Key findings

- Carbapenem use decreased by 30.9% after implementing the augmented PAF strategy.
- Prescriber adherence improved from 25.0% to 58.5% with the enhanced PAF approach.
- The monthly decrease in carbapenem DOT was statistically significant (p=0.017).

## Abstract

At a tertiary hospital in Korea, antimicrobial stewardship program (ASP) activities, including preauthorization for carbapenem use, were suspended in early 2024 due to a nationwide medical strike, leading to increased carbapenem consumption. In response, a PAF strategy was introduced in December 2024 and further enhanced in January 2025 to include compliance monitoring, ward rounds, and follow-up feedback. This study evaluated the impact of the augmented PAF on carbapenem use following ASP suspension and assessed changes in prescriber adherence compared to standard PAF.Trend in carbapenem use expressed as monthly DOT per 1,000 patient-daysCarbapenem DOT/1,000PD decreased after implementation of the augmented prospective audit and feedback (PAF) strategy. December 2024 (standard PAF only) was excluded as transition period.Estimated Changes in Carbapenem Use Following ASP Suspension and Augmented PAF ImplementationInterrupted time series analysis showing a significant reduction in DOT during augmented PAF period compared to ASP suspension period (p=0.017)

Trend in carbapenem use expressed as monthly DOT per 1,000 patient-days

Carbapenem DOT/1,000PD decreased after implementation of the augmented prospective audit and feedback (PAF) strategy. December 2024 (standard PAF only) was excluded as transition period.

Estimated Changes in Carbapenem Use Following ASP Suspension and Augmented PAF Implementation

Interrupted time series analysis showing a significant reduction in DOT during augmented PAF period compared to ASP suspension period (p=0.017)

We retrospectively analyzed monthly carbapenem Days of Therapy (DOT) from January 2021 to March 2025. DOT trends were assessed using interrupted time series analyses based on a linear regression model, comparing the ASP suspension period (March–November 2024) with the subsequent period following implementation of the augmented PAF (January–March 2025). A separate comparison of prescriber adherence rates was conducted between December 2024 (standard PAF only) and January–March 2025 (augmented PAF).

Number of Patients audited, Carbapenem Discontinuations, and Discontinuation Rates Before and After Augmented PAF Implementation

Number of Patients audited, Carbapenem Discontinuations, and Discontinuation Rates Before and After Augmented PAF Implementation

In December 2024 (standard PAF), 7-day natural discontinuations were assessed, whereas from January to March 2025, post-intervention discontinuations were analyzed. Augmented PAF implementation was associated with an increased rate of carbapenem discontinuation.

Following the introduction of the augmented PAF in January 2025, a significant reversal in carbapenem DOT trend was observed, marked by a monthly decrease of 7.174 DOT (95% CI: –13.014 to –1.334; p = 0.017) and a relative reduction of 30.9%. In December 2024, when only standard PAF was implemented, 25.0% (6/24) of patients noncompliant with initial feedback discontinued or modified carbapenem use within 7 days, whereas this rate increased to 58.5% (31/53) following the introduction of augmented PAF with additional feedback after clinical ward rounds from January to March 2025 (p = 0.008).

PAF remains an important core activity of antimicrobial stewardship alongside preauthorization. In this study, implementation of PAF was associated with a reduction in carbapenem use following ASP suspension, and the adoption of an augmented PAF approach incorporating clinical rounding and real-time feedback improved prescriber adherence.

All Authors: No reported disclosures