Antimicrobial stewardship programs have shown to reduce the utilization of inappropriate antimicrobials, reduce the incidence of adverse effects, help prevent emergence of resistance and reduce drug acquisition costs. However data regarding antimicrobial stewardship programs in the community setting is limited and barriers to implement such programs exist. We implemented an antimicrobial stewardship program based on the strategy of a prospective audit with intervention and feedback at a 350 bed community hospital in Winfield, IL. The purpose of this study is to evaluate its impact on the antimicrobial prescribing and utilization at the hospital over a three year period.
An infectious diseases clinical pharmacist audited all inpatients receiving antimicrobial therapy and met with an ID physician to review recommendations. Recommendations were made to physicians via phone and interventions were documented in EPIC computer system and tracked via i-Vents. Physician education, pharmacy protocols, electronic order set implementation and formulary changes were also implemented as a part of stewardship efforts. Total number of interventions, type of intervention, defined daily doses (DDDs; World Health Organization definition) and acquisition costs per patient-day were calculated on a quarterly basis for all administered antimicrobial agents.
Preliminary data for the first 2 years shows that approximately two thousand interventions were made from January 2012 to December 2013. Most common intervention (~ 52%) was discontinuation/de-escalation of therapy followed by guideline adherence (33%) and pharmacokinetic consults (15%). Antibiotic utilization decreased between 2011 and 2012 after the implementation of the program which resulted in a 29% reduction in drug acquisition costs which was maintained in 2013. Procalcitonin testing was introduced in 2014 and analysis to measure its value is ongoing.
The study will add to the growing body of evidence on the positive impact of antimicrobial stewardship programs in the community setting. Prospective audits, implementation of electronic order sets as well as physician education has led to decreased inappropriate use of antimicrobials in the hospital.
R. S. Polisetty,
G. Karnik, None
E. M. Rodriguez, None
G. W. White, None