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De-escalation Number of patients where a de-escalation from the initial
therapy is performed / Total number of indicated
empirical treatments.

IV-to-oral switch Number of regimens switched to oral route / Total number
of regimens that can be switched to oral route based on
predefined criteria.

Compliance with current Number of patients receiving surgical antibiotic
guidelines for surgical prophylaxis according to guidelines / Total number of
prophylaxis (antibiotics) surgical patients receiving antibiotic prophylaxis.

Surgical prophylaxis within Surgeries with prophylaxis administered within 60
the previous 60 minutes minutes prior to surgery / Total number of surgeries that
require prophylaxis.

Surgical prophylaxis stopped Surgeries with prophylaxis stopped within 24 hours after
within 24 hours after surgery surgery / Total number of surgeries that require
prophylaxis.

(Adapted from WHO toolkit: Antimicrobial Stewardship Programmes in Healthcare Facilities
in Low- and Middle-income Countries)

Outcome Measures (After AMS Interventions)

i. Outcomes related to antimicrobial use:
• DDD per 1000 patient-days
• DDD per 100 admissions
• DOTs per 1000 patient-days
• Proportion of DDDs in AWaRe and OTHER groups

ii. Outcomes related to patients and microbiology:
• Patient outcomes
In-hospital mortality, length of stay, readmission within 30 days after discharge.

• Microbiology outcomes
Clostridium difficile / MDR organisms:
Number of healthcare-associated infections in a period of time / Total number
of patient days within that period x 100 000.

42 Protocol on Antimicrobial Stewardship (AMS) Programme in Healthcare Facilities | Second Edition 2022