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Each year, two million Americans acquire serious infections caused by bacteria that are resistant to antibiotics resulting in significant morbidity, mortality, health care utilization and costs. Despite the recent passage of an antimicrobial stewardship programs (ASP) mandate in California and the Centers for Disease Control and Prevention (CDC) guidelines for a minimum standard ASP in hospitals, literature on the impact of ASPs on antimicrobial resistance (AMR) rates in hospitals is sparse. The long-term goal of this study is to provide reliable evidence to influence policies and practices to reduce AMR and improve quality and clinical outcomes in hospitals. The overall objective of this study was to investigate the impact of ASP adoption, including the effect of a mandate in California and compliance with the CDC’s 7 core elements on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (C. diff) in acute care hospitals. Then, we investigated their impact on selected quality and clinical outcomes. In paper 1, we estimated the impact of passing an ASP mandate in California on hospital on MRSA and C. diff rates using 2013-2017 hospital-level data and a difference-in-difference with hospital fixed effects (FE) design. We found that, compared to hospitals in other states, California hospitals had significant (p |
