185. The Positive Impact of an Antimicrobial Stewardship Program(ASP) in a Community Hospital Non-ICU Setting
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
  • IDSAfinalposter.pdf (193.8 kB)

    Background:  Prospective audit and feedback has been demonstrated in randomized controlled trials to be effective in reducing inappropriate use of antimicrobials and is considered a core strategy in the IDSA/SHEA guidelines. Little evidence is available regarding successful implementation of an ASP in the non-ICU community based setting.  The goals of our ASP are to reduce the use and expenditure of antimicrobials and reduce rates of nosocomially acquired C.difficile. 

     Methods:  The ASP began on surgical units in July 2010 and on the respiratory unit in October 2010. Our ASP utilizes an audit and feedback methodology carried out by an Infectious Disease physician-pharmacist team. Antimicrobial optimization is based on published treatment guidelines. An automated Days of Therapy (DOT) report based on doses administered to the patient via an electronic medication record was used as the primary metric for capturing antimicrobial utilization. Antimicrobial expenditures were obtained from Pharmacy financial charging data and presented as antimicrobial cost/patient day. Outcome metrics on mortality, 7 day readmission and average length of stay were standardized by patient day (PD).

     Results:  The ASP has demonstrated substantial reductions in antimicrobial costs. There was a 28% reduction in average antimicrobial cost/PD on the respiratory unit ($9.11 vs. $6.55, p=0.05). Similarly, there was a 37.5% decrease in antimicrobial cost/PD on the surgical units ($5.42 vs. $3.39, p=0.002). In addition, on the respiratory unit there was a significant reduction in moxifloxacin (p<0.01) and meropenem (p=0.04) utilization. As well, on the surgical ward there was a significant increase in use of amoxicillin-clavulanic acid (p<0.001) and a decrease in the use of ciprofloxacin (p<0.005), clindamycin (p=0.01) and meropenem (p<0.05). The rates of nosocomially acquired C.difficile. on the ASP units has decreased (NS). Quarterly mortality, 7 day readmission rates and LOS were not significantly changed after ASP introduction.

     Conclusion:  Implementation of an ASP utilizing prospective audit and feedback in a community hospital has shown significant cost and antimicrobial utilization reductions without negatively impacting patient outcomes.

    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Suzanne Gill, BscPhm1, Carmine Stumpo, BscPhm, ACPR, PharmD1, Valerie Leung, BscPhm, ACPR2 and Jeff Powis, MD, MSc, FRCPC3, (1)Pharmacy, Toronto East General Hospital, Toronto, ON, Canada, (2)Canada Health Infoway, Toronto, ON, Canada, (3)Infectious Disease, Toronto East General Hospital, Toronto, ON, Canada


    S. Gill, None

    C. Stumpo, None

    V. Leung, None

    J. Powis, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.