How to Save Half a Million Dollars: An Antimicrobial Stewardship Program in a Tertiary Care Center

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

Download Full-text

1064. Antimicrobial Stewardship Program at a Large Academic Medical Center, Impact Over 12 Years

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.928 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S376-S377

Author(s):

Susan E Kline ◽

Kimberly Boeser ◽

Jeana Houseman ◽

Samantha Saunders ◽

Shawnda Johnson ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Care Facility ◽

Downward Trend ◽

Full Time ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Hospital Acquired

Abstract Background The University of Minnesota Medical Center (UMMC) is a tertiary care facility, which has had a comprehensive antimicrobial stewardship program (ASP) for 12 years. Methods The antimicrobial stewardship team is comprised of a full-time PharmD and ID staff physicians. Recommendations are placed in the electronic medical record as a progress note. Verbal recommendations may also be made. Results There was a downward trend in Hospital-acquired (HA) C. difficile diarrhea from 2007 to 2014 from 1.2 to 0.5/1000 patient-days (pt day). Rates appear stable from 2014 to 2019 with adjustment for change to NHSN lab-based CDI surveillance (Figure 1). From 2009 to 2019 a decrease was seen in VRE hospital-acquired infections (HAI) from 0.53 to 0.21/1,000 patient-days and in MRSA HAIs from 0.2 to 0.14/1,000 patient-days. Newly acquired ESBL HAIs have remained relatively stable from 2009 to 2019 at 0.09 to 0.05/1,000 patient-days. CRE HAIs are low but stable rates at 0.02/1,000 patient-days (Figure 2). We track antimicrobial utilization for internal and national reporting (starting in July 2017). A SAAR for all Antibacterial agents (ICUs, wards, and oncology units) of 1.33 in 2018. Our top four agents average DOT; piperacillin/tazobactam (66.81), cefepime (34.40), oral levofloxacin (23.56) and intravenous meropenem (21.49). We demonstrate lower average DOT for our restricted antimicrobials (206.21) as compared with our nonrestricted antimicrobials (236.74) (Figure 3). Cost savings continued from year to year. After adjusting for inflation annually, our expected costs ($84.08) compared with actual costs ($40.12 ytd 2019), demonstrates effective cost management of antimicrobial agents. (Figure 4) Conclusion We observed a decrease in HAIs VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. This downward trend has continued. ESBL HAIs remain relatively stable and CRE are stable at low rates but remain emerging HAIs of concern. We are now focusing efforts on limiting unneeded fluoroquinolone and carbapenem use. We continue to analyze our SAAR data and internal DOT data to identify areas of opportunity to improve antimicrobial use. The ASP outcomes have continued to cost justify ongoing efforts. The effects of the program and the Infection Prevention Department appear to be synergistic. Disclosures All authors: No reported disclosures.

Download Full-text

Impact of Antimicrobial Stewardship Program (ASP) on Outcomes in Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) in an Acute-Tertiary Care Hospital

Infectious Diseases and Therapy ◽

10.1007/s40121-015-0085-7 ◽

2015 ◽

Vol 4 (S1) ◽

pp. 15-25 ◽

Cited By ~ 13

Author(s):

Li Wen Loo ◽

Yi Xin Liew ◽

Winnie Lee ◽

Piotr Chlebicki ◽

Andrea Lay-Hoon Kwa

Keyword(s):

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Skin Structure ◽

Stewardship Program

Download Full-text

The implementation and outcome of a 2-year prospective audit and feedback based antimicrobial stewardship program at a private tertiary care hospital

Indian Journal of Medical Microbiology ◽

10.1016/j.ijmmb.2021.09.005 ◽

2021 ◽

Author(s):

Pooja Thakkar ◽

Tanu Singhal ◽

Sweta Shah ◽

Rohit Bhavsar ◽

Shweta Ladi ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Audit And Feedback ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Prospective Audit ◽

Stewardship Program ◽

Prospective Audit And Feedback

Download Full-text

Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv009 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 5

Author(s):

Neil M. Vora ◽

Christine J. Kubin ◽

E. Yoko Furuya

Keyword(s):

New York ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Categorical Variables ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Gram Negative ◽

Stewardship Program

Abstract Background. Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods. We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results. A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions. Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

Download Full-text

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

Infection Control and Hospital Epidemiology ◽

10.1086/664909 ◽

2012 ◽

Vol 33 (4) ◽

pp. 338-345 ◽

Cited By ~ 140

Author(s):

Harold C. Standiford ◽

Shannon Chan ◽

Megan Tripoli ◽

Elizabeth Weekes ◽

Graeme N. Forrest

Keyword(s):

Infectious Diseases ◽

Cost Analysis ◽

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Fiscal Year ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Large Tertiary Care

Background.An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.Design.A descriptive cost analysis before, during, and after the program.Patients/Setting.A large tertiary care teaching medical center.Methods.Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.Results.The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.Conclusions.The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

Download Full-text

Sustained Savings from a Longitudinal Cost Analysis of an Internet-Based Preapproval Antimicrobial Stewardship Program

Infection Control and Hospital Epidemiology ◽

10.1086/670625 ◽

2013 ◽

Vol 34 (6) ◽

pp. 573-580 ◽

Cited By ~ 40

Author(s):

Anna C. Sick ◽

Christoph U. Lehmann ◽

Pranita D. Tamma ◽

Carlton K. K. Lee ◽

Allison L. Agwu

Keyword(s):

Cost Analysis ◽

Antimicrobial Stewardship ◽

Tertiary Care ◽

Cost Savings ◽

Antimicrobial Stewardship Program ◽

Pediatric Hospital ◽

Antimicrobial Prescribing ◽

Approval Rate ◽

Stewardship Program ◽

Sustained Reduction

Objective.To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.Design.Retrospective cohort study and cost analysis.Methods.Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.Results.Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.Conclusions.A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.

Download Full-text