Research needs in antibiotic stewardship

High-value targets for antibiotic stewardship (AS) research Clinical Evidence to Define Optimal Antibiotic Use Implementation Metrics Study Design and Methods Evaluate optimal diagnosis and antibiotic management (dose, route, duration) of pneumonia, urinary tract infections, skin and soft tissue infections, diabetic foot infection, and intra-abdominal infections Use diagnostic stewardship to drive practice change in antibiotic prescribing Establish the role and optimal duration of antibiotic prophylaxis in a variety of settings, including in immunocompromised patients Study various strategies to establish comparative effectiveness, feasibility, and costs Identify the most effective computerized decision support for AS interventions Incorporate social, organizational, emotional, and cultural drivers into the design of AS interventions Identify strategies for promoting dissemination of evidence-based stewardship in primary care, urgent care, and emergency departments Identify elements of sustainable AS Develop models for effective AS in varied (non-acute care) settings Identify key components of effective AS programs utilizing remote AS expertise and training of non-infectious diseases trained healthcare personnel Design cutting edge implementation studies to scale up proven interventions Evaluate optimal staffing for AS Identify valid and informative antibiotic use metrics for diverse hospital and non-hospital settings Study methods for assessing and comparing post-discharge antibiotic therapy Improve methods to evaluate outpatient antibiotic prescribing Develop metrics to assess “appropriate use” of antibiotics Identify, define, test, and validate AS process measures with a demonstrable link to clinically meaningful outcomes Quantify the risk of acquiring antibiotic-resistant pathogens based on antibiotic selection, dose, and duration Develop a core set of standardized, meaningful clinical outcome variables Measure outcomes post-antibiotic consumption Invest in research infrastructure to facilitate interventions and analysis at the patient and population levels Set standards for process and outcomes in quasi-experimental and observational studies Perform comparative effectiveness studies evaluating clinical outcomes as a function of antibiotic exposure using study designs that minimize or avoid biases (e.g. multisite cluster-randomized and crossover trials) Use study designs and statistical methods that address competing benefits and risks associated with