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Antimicrobial Stewardship in Acute Care

Approximately 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal. Serious adverse effects occur in roughly 20% of hospitalized patients who receive antibiotics. Hospital antimicrobial stewardship programs are crucial to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antimicrobial resistance.

In 2024, reporting to the National Healthcare Safety Network (NHSN) Antimicrobial Use and Resistance (AUR) Module became a required measure under the Public Health and Clinical Data Exchange objective of the CMS Promoting Interoperability Program. Beginning with the EHR reporting period in 2025, the AUR Surveillance measure has been split into two separate measures: AU Surveillance and AR Surveillance. Each measure has its own set of exclusions and reporting requirements. Eligible hospitals and Critical Access Hospitals must report a ‘‘Yes’’ response to being in active engagement (Option 1 or Option 2) with CDC’s NHSN to submit Antimicrobial Use (AU) and Antimicrobial Resistance (AR) data for the EHR reporting period in 2025 to fulfill measure requirements. Eligible hospitals and CAHs may also claim an applicable exclusion for one or both measures separately.

Eligible hospitals and CAHs that claim an applicable exclusion for only AU or AR would either need to be in active engagement for the other measure or claim a separate exclusion. For example, if claiming an exclusion for the AR Surveillance measure due to lack of access to discrete data elements, the eligible hospital or CAH must be in active engagement for the AU Surveillance measure or claim an applicable exclusion specific to the AU measure.

Eligible hospitals and CAHs that report a ‘‘No’’ response to either measure, fail to report any response, or fail to claim an applicable exclusion will not receive credit for the measure(s). These eligible hospitals and CAHs would fail to satisfy requirements of the Public Health and Clinical Data Exchange Objective and will earn a score of zero for the Medicare Promoting Interoperability Program.

Facilities can be in active engagement in two ways:

  • Option 1 – Pre-production and Validation

Note: Because the AU and AR Surveillance measures have been split for the EHR reporting period in 2025, eligible hospitals and CAHs can spend an additional calendar year in “Option 1 – Pre-production and Validation” (specifically, Option 1 for both 2024 and 2025) before being required to move to “Option 2 – Validated Data Production” in 2026

  • Option 2 – Validated Data Production

For the EHR reporting period in 2024 and forward, eligible hospitals and CAHs must submit any continuous 180-days of AUR data to NHSN.

For more information and additional resources, please see the materials in the Antimicrobial Use and Resistance section of CMS Reporting Requirements for Acute Care Hospitals page. Please direct questions about NHSN AUR Reporting to the NHSN Helpdesk: NHSN@cdc.gov.

The following IDPH-funded antimicrobial stewardship activities support acute care settings across Illinois:

Resources