965. Impact of an Antimicrobial Stewardship Program in a Safety-Net Hospital with Low Baseline Antibiotic Use
Session: Poster Abstract Session: Stewardship: Epidemiology of Antibiotic Use
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:   Antimicrobial stewardship programs can reduce antibiotic use and costs in both academic and community hospitals; however, their impact in safety-net hospitals and those with already low antibiotic use has not been described.  We evaluated the effects of a stewardship program implemented in a safety-net hospital with low baseline antibiotic use.

Methods: Denver Health is an academic public safety-net hospital.  Antibiotic use was nearly the lowest among University Health Consortium hospitals prior to implementation of a formal stewardship program in July 2008.  We performed a before-after study to evaluate outcomes during a 2-year baseline period immediately prior to the program (7/1/06 – 6/30/08) and the 4.5 years after its inception (7/1/08 – 12/31/12).  The primary outcome was the change in total antibiotic use between the two periods.  Secondary outcomes were changes in use of antibiotics active against Pseudomonas aeruginosa, rate of hospital-onset Clostridium difficile infection (CDI), length of stay, in-hospital mortality, and 30-day readmission rates for patients who received an antibiotic, and antibiotic-acquisition costs. 

Results: Between the baseline and stewardship periods, mean total antibiotic use decreased 7% from 604 to 563 days of therapy (DOT) per 1000 patient-days (PD) (p<.001).  Mean use of anti-pseudomonal agents decreased 20% from 187 to 150 DOT/1000PD (p<.001), including significant reductions in imipenem (22 vs. 5 DOT/1000PD, p<.001), fluoroquinolones (61 vs. 45 DOT/1000PD, p<.001), and aminoglycosides (26 vs. 19 DOT/1000PD, p = .002).  The rate of hospital-onset CDI remained stable between periods.  For patients who received an antibiotic, mean length of stay decreased (7.0 vs. 6.4 days, p<.001); in-hospital mortality (2.2 vs. 2.1%, p = .36) and 30-day readmission rates (13.9 vs. 14.5, p = .16) were similar.  Antibiotic acquisition costs decreased 19% from $10,299 to $8,360/1000PD (p = .008) 

Conclusion: Implementation of a stewardship program in a safety-net hospital with low baseline antibiotic use was associated with reductions in total and broad-spectrum antibiotic use and cost savings.  This work adds to the literature demonstrating the success of stewardship programs in a variety of hospital settings and suggests that there is the potential for benefit in hospitals with relatively low antibiotic use.

Timothy Jenkins, MD, Michelle Haas, MD, Bryan Knepper, MPH, MSc, Connie Price, MD, William Burman, MD and Philip Mehler, MD, Denver Health Medical Center, Denver, CO


T. Jenkins, None

M. Haas, None

B. Knepper, None

C. Price, None

W. Burman, None

P. Mehler, None

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