Characteristics and framework analysis of Department of Defense hospital Antibiotic Stewardship Programs guided by the Centers for Disease Control and Prevention Core Elements

Objective: Characterization and assessment of Department of Defense's (DoD's) Antibiotic Stewardship Programs (ASPs) to determine adherence to Centers for Disease Control and Prevention (CDC) Core Elements and compare to national adherence Design: Retrospective, observational with supplemental survey Methods: Facility characteristics and CDC Core Elements (CE) adherence data for 2017-2021 were retrieved from the National Healthcare Safety Network's (NHSN) annual hospital survey with DoD data from the Defense Health Agency and national data from the Antibiotic Resistance and Patient Safety Portal. An online supplemental survey was administered to DoD hospitals. Descriptive statistics and bivariate analyses were completed for facility characteristics and supplemental survey questions to determine correlations between variables. A framework analysis compared DoD ASPs to CEs and Priority Elements. Results: Supplemental surveys were completed for 85.1% of DoD's hospitals. DoD's hospitals were smaller on average than national hospitals. ASP leaders were assigned more often than volunteer and typically served in the role for less than four years. Staffing mix differed, with more equivalent proportions of civilian/contractor to military at larger hospitals in the U.S. Most DoD ASPs consisted of ≤ 25% pharmacists. ASP leaders were largely available on a daily basis; pharmacist leaders spent more time on ASP activities than physicians. CE adherence was high, but in 2021 DoD lagged national adherence in the structural CEs of Leadership, Accountability, and Pharmacy Expertise. Conclusions: DoD hospitals lagged in national adherence to the structural CEs, presenting opportunities for ASP improvement. Refinement of CE adherence measurements, coupled with impact on health outcomes, could aid in better-identifying areas for improvement.