Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The IDSA antimicrobial stewardship guideline describes interventions to improve antibiotic utilization, but there is no guidance as to where limited resources are most effectively focused when developing an antibiotic stewardship program (ASP).
Methods: As an initial ASP intervention at our institution, we implemented a prospective audit and provider feedback program in the medical intensive care unit (MICU) on August 1, 2008. An Infectious Diseases (ID) attending or ID pharmacist performed targeted medical record reviews of patients on antibiotics 5-times weekly and provided feedback and education to providers on a case-by-case basis. An ID attending participated in multidisciplinary rounds twice weekly. A similar intervention was continued in our surgical intensive care unit (SICU). We compared antibiotic utilization, costs, and outcomes during the 9 months after the intervention (Aug 08-Apr 09) and the same period in the year prior (Aug 07-Apr 08).
Results: Post-intervention antibiotic utilization decreased by 10.4% in the MICU (1194 days of therapy per 1000 patient-days [DOT/1000PD] to 1070 DOT/1000PD, p=0.08) and by 11.2% in the SICU (1050 to 932 DOT/1000PD, p=0.02) compared with the pre-intervention period. Antibiotic utilization decreased by 24.9% (862 to 647 DOT/1000PD, p=.001) in the step-down unit (SDU) and by 9.5% for remaining medical-surgical wards (661 to 598 DOT/1000PD, p=.004) despite no targeted intervention to these units or providers. Anti-pseudomonal antibiotic use decreased in the MICU, SICU, SDU, and medical-surgical wards by 21.7%, 28.4%, 31.8%, and 15.0%, respectively (p<.05 for each). Antibiotic acquisition costs for these hospital units decreased by a total of $108,218. Length of hospital stay, mortality, and 30-day readmission rates were similar between periods for patients receiving at least one dose of an antibiotic.
Conclusions: An antibiotic stewardship intervention targeted to ICUs was associated with significant reductions in hospital-wide antibiotic utilization and costs. Our experience suggests ICUs are a high-yield area of focus when developing an ASP.