175. Impact of an Antimicrobial Stewardship Program at the University of Minnesota Medical Center,The First 4 Years, 2007-2010
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: Jan 2007 we began a new Antimicrobial Management Team (AMT) at the University of Minnesota Medical Center and U of M Children’s Hospital, Fairview (UMMC/UMCH), University Campus, a 300 bed tertiary care facility.

Methods:  The AMT program allows providers to order restricted antibiotics, per hospital guidelines, without upfront approval. A chart review is done the following day, M-F, by a dedicated Pharm D and a M.D. with ID expertise. Recommendations are placed in the electronic medical record as an AMT note. Verbal recommendations may also be made. The old restricted antibiotic program required the prescriber to get pre-approval to use a restricted antibiotic from the on call ID doctor. Despite this we saw inappropriate utilization and increasing costs.

Results:  Cost saving for the first two years of the AMT were $732,758. AMT Interventions: There were 8015 interventions/recommendation in the first 42 months, 4911 (61.3%) were accepted, 1392 (17.4%) agreed with management, 1712 (21.4%) of the recommendations were declined. From 2006-2008 antimicrobial doses/patient day declined by 7%, antibiotics costs declined by $7.40/patient day, average number of antibiotics per adult patient declined from 2.34 to 2.39 (2.1%) and from 2.98 to 2.37 (20.5%) per pediatric patient. UHC data 2006-2009 showed no significant change in LOS and mortality index. The numbers of patients with hospital acquisition (HA) of VRE, MRSA, and ESBLs did not decline from 2006 to 2009. There was a downward trend in HA Clostridium difficile diarrhea from Jan. 2007 to Feb. 2010.  From 2009 to 2010 a decrease was seen in HA VRE infections from 0.5 to 0.3/1000 patient days and in HA MRSA infections from 0.2 to 0.1/1000 patient days. During 2009-2010 new infection prevention practices were also put in place including environmental cleaning with microfiber clothes, daily bed bathes with chlorhexidine gluconate (CHG) clothes in high risk patients and CHG patch at central line sites.

Conclusion: The AMT was able to reduce antibiotic use and antibiotic costs per patient day. Quality of care was not adversely affected. At the end of the four year period there was a decrease seen in HA MRSA and VRE infections. The effects of the AMT and the Infection Prevention Department appear to be synergistic.

 


Subject Category: A. Antimicrobial agents and Resistance

Susan Kline, MD, MPH1, Kimberly Boeser, Pharm D2, Christine Hendrickson, RN, BSHA3, Anita Guelcher, RN, BSN3, Peggy Bonnell, RN, BSN3, Teresa Rakoczy, RN, BSN3 and Pamela Phelps, Pharm D2, (1)ID Division, Univ of MN, Minneapolis, MN, (2)Pharmacy, University of Minnesota Medical Center , Fairview and University of Minnesota Amplatz Children's Hospital, Minneapolis, MN, (3)Infection Prevention, University of Minnesota Medical Center , Fairview and University of Minnesota Amplatz Children's Hospital, Minneapolis, MN

Disclosures:

S. Kline, None

K. Boeser, None

C. Hendrickson, None

A. Guelcher, None

P. Bonnell, None

T. Rakoczy, None

P. Phelps, 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.