Clinical and economic outcomes from a community hospital's antimicrobial stewardship program

• Published in: American journal of infection control Vol. 41; no. 2; pp. 145 - 148
• Main Authors: Malani, Anurag N., MD, Richards, Patrick G., PharmD, Kapila, Shikha, PharmD, Otto, Michael H., MD, Czerwinski, Jennifer, BS, Singal, Bonita, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2013; Elsevier; Mosby-Year Book, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - economics; Antimicrobial agents; Antimicrobial management; ASP; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacterial infections; Bacterial Infections - drug therapy; Biological and medical sciences; Clinical outcomes; Clostridium difficile; Clostridium difficile infection; Community health care; Drug Prescriptions - standards; Epidemiology. Vaccinations; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Gram-positive bacteria; Health Care Costs - statistics & numerical data; Hospitals, Community; Human bacterial diseases; Humans; Infection Control; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Non-university teaching hospital; Organizational Policy; Other diseases. Semiology; Outcomes; Recurrence; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; Treatment Outcome; Non-university teaching hospital; Antimicrobial management; Clostridium difficile infection; ASP; Outcomes; Teaching hospital; Prognosis; Clostridium difficile; Clostridiales; Check; Diarrhea; Antimicrobial agent; Prevention; Infection; Clinical management; Clostridiaceae; Bacteria; Digestive diseases; Intestinal disease; Hospital
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2012.02.021

Background Data from community antimicrobial stewardship programs (ASPs) are limited. We describe clinical and economic outcomes from the first year of our hospital's ASP. Methods The ASP team comprised 2 infectious disease physicians and 3 intensive care unit pharmacists. The team prospectively audited the new starts and weekly use of 8 target antimicrobials: aztreonam, caspofungin, daptomycin, ertapenem, linezolid, meropenem, tigecycline, and voriconazole. Using administrative data, outcomes from the first year of the program, including death within 30 days of hospitalization, readmission within 30 days of discharge, and development of Clostridium difficile infection (CDI), were compared with outcomes from a similar period before institution of the program. Results A total of 510 antimicrobial orders were reviewed, of which 323 (63%) were appropriate, 94 (18%) prompted deescalation, 61 (12%) were denied, and 27 (5%) led to formal consultation with an infectious disease physician. On multivariate analysis, implementation of the ASP was associated with an approximate 50% reduction in the odds of developing CDI (odds ratio, 0.46; 95% confidence interval, 0.25-0.82). The ASP was not associated with decreased mortality at 30 days after discharge or readmission rate. The antimicrobial cost per patient-day decreased by 13.3%, from $10.16 to $8.81. The antimicrobial budget decreased by 15.2%, resulting in a total savings of $228,911. There was a 25.4% decrease in defined daily doses of the target antimicrobials. Conclusions Implementation of the ASP was associated with significant reductions in CDI rate, antimicrobial use, and pharmacy costs.