Impact of an Antimicrobial Stewardship Program (ASP) on antimicrobial use and clinical outcomes at a Veterans Affairs (VA) Teaching Hospital
Methods: In September 2012, a formal ASP was implemented at a VA teaching hospital licensed for 118 beds. The ASP team of attending and fellow ID physicians, a clinical ID pharmacist and fellow, and pharmacy residents and students prospectively audited all inpatient antimicrobial use (IV and PO) daily (Monday-Friday). Antimicrobial use and clinical outcomes were compared between inpatients on antimicrobials in a 1 year period before (pre-ASP; Oct 2010 -Sept 2011) and after (post-ASP; Sept 2012-Aug 2013) ASP implementation. Poisson regression models were used to calculate adjusted relative risk (RR) and 95% confidence intervals (CI) to assess ASP impact on inpatient mortality, 30-day readmission, and 14 day length of stay.
Results: Post-ASP implementation, 522 interventions were made with an acceptance rate of 77%. A total of 2659 pts (49% pre-ASP; 51% post-ASP) were included for evaluation. IV antimicrobial use in pre- and post- ASP pts decreased from 293 to 288 days of therapy (DOT)/ 1000 patient days (PD) and PO antimicrobial use increased from 186 to 209 DOT/ 1000 PD. The DOT/1000 PD of several broad spectrum antimicrobial agents decreased from pre- to post- ASP periods, including piperacillin-tazobactam (-6%), 3rd/4th generation cephalosporins (-13%), fluoroquinolones (-20%), and carbapenems (-35%). IV vancomycin DOT/1000 PD increased 6% from the pre- to post-ASP periods. Post-ASP implementation, inpatient mortality decreased significantly (adjusted relative risk [RR] 0.59, 95% CI 0.35 - 0.99), 14 day length of stay decreased non-significantly (RR 0.78, 95% CI 0.61 - 1.01) and 30-day readmission increased non-significantly (RR 1.05, 95% CI 0.91 - 1.21).
Conclusion: Our ASP was associated with improvements in use of several broad spectrum antimicrobials and clinical outcomes, including inpatient mortality and length of stay. However, further ASP efforts are needed to improve vancomycin use and 30-day readmission rates.
M. Gaitanis, None
K. Laplante, Astellas, Cubist, Forest, the National Institutes of Health, Pfizer, Theravance, Marvao, Davol, Durata, Cepheid : Research funding, advisor, and/or consultancy and Scientific Advisor, Research grant