Impact of an eConsult-based antimicrobial stewardship program using the ExpertTWIN system: a Bayesian structural time-series analysis
Abstract
Abstract Objective: Antimicrobial stewardship programs (ASPs) are difficult to implement in hospitals with limited access to infectious disease (ID) specialists. Electronic consultation–based tele-stewardship may offer a scalable solution; however, evidence regarding its implementation and impact remains limited. This study evaluated the impact of an eConsult-based remote antimicrobial stewardship program on antimicrobial consumption and resistance patterns. Design: Single-center retrospective observational study. Setting: A 500-bed tertiary care hospital without on-site ID specialists. Patients: In total, 27,863 patients were hospitalized. Interventions: An asynchronous eConsult-based tele-stewardship program using the ExpertTWIN system was implemented in February 2025. Data from February 2024 to January 2026 were analyzed using a Bayesian structural time-series model. Results: During the intervention period, 145 cases were reviewed. Carbapenem use decreased; use of antipseudomonal and narrow-spectrum agents showed evidence of increases, whereas use of anti-MRSA agents and total oral and intravenous antimicrobial use showed evidence of reductions. The incidences of carbapenem-resistant Pseudomonas aeruginosa, two-drug-resistant P. aeruginosa, and MRSA showed evidence of reductions, whereas third-generation cephalosporin-resistant Escherichia coli increased. Culture specimen submission showed evidence of an increase. There was no clear evidence of reductions in all-cause in-hospital mortality or length of stay. Total antimicrobial costs were unchanged. Conclusions: The eConsult-based tele-stewardship program reduced carbapenem use and was associated with favorable changes in several antimicrobial-use, resistance, and diagnostic measures, although third-generation cephalosporin-resistant E. coli increased. No clear changes in clinical outcomes were observed. This model may offer a practical and scalable ASP strategy for hospitals without on-site ID specialists.