In 2015, the Centers for Disease Control and Prevention developed the Standardized Antimicrobial Administration Ratio (SAAR) to account for underlying differences in patient characteristics that differ between facilities and increase antibiotic use. Although significant effort went into the development of the SAAR metric, several aspects required scientific advancement: 1) the models were not externally validated, 2) SAAR risk-adjusts only for facility-level characteristics, meaning the validity and utility may be sub-optimal, and 3) there are no data to support that risk-adjusted antibiotic use rates are correlated with appropriate antibiotic use. In this dissertation, my objective was to validate and refine current antibiotic utilization metrics to better support stewardship efforts in the hospital.