985. Comparative-effectiveness of a Multifaceted Antimicrobial Stewardship Program in a Large, Urban, Healthcare System
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: To compare broad-spectrum antimicrobial use, total antibiotic expenditures, and healthcare associated infections in two hospitals implementing a multifaceted antimicrobial stewardship program to two similar hospitals not implementing the program.

Methods: In mid-fiscal year 2009, the Seton Healthcare Family (Austin, TX) implemented an antimicrobial stewardship program in two of its fifteen hospitals. The program involved provider education, antimicrobial review and restriction policies, and targeted cost-savings initiatives. Two infectious diseases pharmacists were empowered by the multidisciplinary antimicrobial stewardship team to review all antimicrobial orders and culture reports daily for appropriateness and to ensure that the antimicrobials were guideline-concordant, dose-optimized, and the narrowest spectrum of activity against the offending pathogen(s). To assess the effectiveness and fiscal impact of this program, descriptive statistics were used to demonstrate antimicrobial use, costs, and rates of healthcare associated Clostridium difficile infection in these two acute care hospitals vs. similar hospitals within the same healthcare system.  

Results: Study hospitals experienced a reduction in the use of broad-spectrum antimicrobials associated with collateral damage: fluoroquinolones (64-66%), ceftriaxone (31-49%), and clindamycin (10-37%). Healthcare associated C. difficile infection was reduced (62-82%) and a decrease in total annual antibiotic expenditures was demonstrated (49-56%; $509-$777K). In comparison to non-study hospitals, study hospitals showed fewer days of therapy per 1000 patient days vs. control hospitals:  fluoroquinolones (44-47 vs. 147-154), ceftriaxone (40-41 vs. 76-91), and clindamycin (24-41 vs. 40). Study hospitals also showed fewer healthcare associated C. difficile infection cases/1000 patient days vs. control hospitals: (0.07-0.16 vs. 0.28-0.29). Finally, study hospitals experienced a lower overall antibiotic cost per adjusted patient discharge vs. control hospitals ($26-28 vs. $38-47).

Conclusion: A multifaceted antimicrobial stewardship program was associated with improvements in broad-spectrum antimicrobial use, total antibiotic expenditure, and healthcare associated infections.

Katherine Shea, PharmD1, Theresa Jaso, PharmD1, Jack Bissett, MD2, Gordon Huth, MD3 and Christopher R. Frei, PharmD, MSc4, (1)Seton Healthcare Family, Austin, TX, (2)Austin Infectious Disease Consultants, Austin, TX, (3)University of Texas Southwestern-Austin Programs, Austin, TX, (4)Univ. TX, San Antonio, TX


K. Shea, None

T. Jaso, None

J. Bissett, None

G. Huth, Johnson & Johnson: Shareholder, stock
Abbott: Shareholder, stock

C. R. Frei, AstraZeneca: Grant Investigator, Research grant
Bristol Myers Squibb: Grant Investigator, Research grant
Elan: Grant Investigator, Research grant
Forest: Board Member, Consulting fee
Pfizer: Grant Investigator, Research grant
Ortho-McNeil Janssen: Board Member, Consultant and Grant Investigator, Consulting fee and Research grant

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