Demonstrating Value For Antibiotic Stewardship Program (ASP) Through Cost Saving, Improved Antimicrobial Resistance Patterns And Stable Clinical Outcomes In A Community Hospital Setting Over A 3 Year Period

Background: ASP offers an opportunity to demonstrate the value by reducing costs and improving care.   Most studies have looked at the reduction in costs. We include observations of antimicrobial susceptibility, prevalence of Clostridium difficile,and hospital mortality as outcome measures.

Methods: A multi-disciplinary ASP was convened in a 355 bed community medical center.  The team developed order sets, optimized antibiotic dosing, and monitored antimicrobial usage. Regular review by an experienced infectious disease clinician and pharmacist on rounds to evaluate individual cases was performed using predetermined screening criteria of > 2 antimicrobials, use of any restricted antimicrobial, use of piperacillin/tazobactam, and any mismatch of susceptibility to culture results.  Rounds were performed weekly and feedback was provided via physician-to-physician communication.  Data were tracked, recorded and tallied for 3 years.   Case mix index was used to evaluate severity of illness.

Results: From 2010 to 2012 antimicrobial utilization decreased by 32% ($288,000), dollars per hospital day decreased by 25% and antibiotic dollars as percent of hospital formulary declined from 10 to 7.3% .   During this same time the prevalence of extended spectrum beta lactamase producing Klebsiella spp. decreased by 34%, methicillin resistant Staphylococcal aureus by 9%, and carbapenamase producing Pseudomonas spp. by 35%. The frequency of Clostridium difficile increased but interpretation of this change is confounded by a change to a molecular assay.  Case mix index increased by 5% and an absolute increase of 0.5% was seen in all-cause mortality. The difference in mortality was not significant.

Conclusion: We demonstrated that a coordinated program for addressing antibiotic stewardship in a community hospital brings value by reducing costs and improving safety.   Such programs should be aggressively deployed, supported and vested with appropriate authority to implement accepted standards for antimicrobial utilization.

                                                                        

Antibiotic Use For Three Years
Year	Total $	Total Pharma $	Hosp Days	Discharges	ABX/TOT	ABX/ Hosp Day
2010	900,016	8,962,206	78389	16374	10.04%	$11.48
2011	772,908	8,508,616	74850	15931	9.08%	$10.33
2012	611,960	8,384,968	70846	15164	7.30%	$8.64