Background: Antimicrobial overuse promotes the development of antibiotic resistant infections and leads to adverse patient outcomes. Antimicrobial Stewardship Programs (ASPs) have been widely implemented to promote judicious antimicrobial use. The bulk of the available literature evaluating the efficacy of ASPs has focused on Intensive Care Units (ICUs) or ASPs targeting broad-spectrum antimicrobials only. We sought to evaluate the impact of an ASP in non-ICU settings where all antimicrobials, regardless of spectrum, were targeted at the time of initiation.
Methods: Antimicrobial stewardship was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. From Monday to Friday, the ASP team carried out prospective audit and feedback on all patients on any systemic antimicrobial. We evaluated rates of antimicrobial use, measured in Days of Therapy (DOTs), among patients admitted to the wards before and after ASP initiation using an interrupted time series analysis. Changes in mean rates of mortality, readmission, length of stay, and C. difficile infection (CDI) were evaluated on each ward using univariate analysis.
Results: On the surgical ward, antimicrobial use decreased from a mean value of 826.4 prior to ASP, to 726.6 after ASP (DOTs/1000 patient care days), representing a 12% reduction (p=0.05). On the respiratory ward, antimicrobial use was reduced from a mean value of 1022.5 before ASP, to 922.4 after ASP (DOTs/1000 patient care days), representing a 10% decrease (p=0.03). On the medical ward, antimicrobial use decreased from a mean value of 459.8 prior to ASP, to 369.1 after ASP, representing a 20% reduction (p<0.01). Reductions in antimicrobial use were sustained over time. Most patient outcomes did not change significantly post intervention, however CDI rates showed a non-significant declining trend.
Conclusion: Antimicrobial Stewardship Programs can lead to sustained reductions in total antimicrobial use outside of the critical care setting when interventions are not limited to broad-spectrum antibiotics. ASP programs outside of critical care units should target all antimicrobials, not only broad-spectrum agents.
G. Ho, None
J. Mccready, None
J. Powis, None