1028. Ongoing Impact of an Antimicrobial Stewardship Program at A Large Academic Medical Center, 9 years of experience
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
  • IDWeek_2016_poster.10.24.16.final.pdf (883.7 kB)
  • Background:      

    The University of Minnesota Medical Center (UMMC) is a 300 bed tertiary care facility.  UMMC has had a long-standing, comprehensive antimicrobial stewardship program (ASP).


    The stewardship team is comprised of a full-time PharmD and ID staff physicians who rotate on the service.  The team allows providers to order restricted antimicrobials, per hospital guidelines and policies, without upfront approval, followed by a chart review.  Recommendations are placed in the electronic medical record as a progress note. Verbal recommendations may also be made.  


    There was a downward trend in Hospital Acquired (HA) C. difficile diarrhea from 2007 to 2014 from 1.2 to 0.5/1000 patient days (pt day). Rates appear stable from 2014-2016 with adjustment for change to NHSN lab based surveillance. (Figure1.) From 2009-2014 a decrease was seen in VRE hospital acquired infections (HAI) from 0.53 to 0.22/1000 pt days and in MRSA HAIs from 0.2 to 0.08/1000 pt days. VRE and MRSA HAI rates increased in 2015 - 2016. Newly acquired ESBL HAIs increased from 2009-2016 at 0.09 to 0.20/1000 pt days. CRE HAIs are an emerging problem.

    Cost savings, after adjusting for inflation, continued from year to year.  The greatest cost savings was from 2006-08 in which antimicrobial doses/pt day declined by 7%, antibiotics costs declined by $7.40/pt day. In 2012, we observed our lowest antibiotic cost/pt day at $36.36 which is a difference of $19.03 before implementation of the program. From 2013-2015, we have observed a sustained average antibiotic cost per patient day of $42.84. 


    We began to observe a decrease in HA VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. The ASP has continued to cost justify the program. Our antibiotic costs/pt day have leveled off in the last 3 years and remained low despite rising antibiotic costs due to market inflation and drug shortages. The effects of the program and the Infection Prevention Department appear to be synergistic. Future areas for focus include preventing rising MDRO HAIs, focus on non-restricted antibiotics that contribute to C. difficile diarrhea and use of the procalcitonin test to help optimize antibiotic use.


    Figure 1.       



      Figure 2.     


    Susan Kline, MD, MPH, FSHEA1, Kimberly Boeser, PharmD, BCPS AQ-ID2, Pamela Phelps, Pharm D3, Dawn England, MPH, CIC4, Samantha Saunders, MPH5, Kari Lawrence, MPH, BBA5 and Jessica Kanklefitz, BA5, (1)Department of Medicine, Infectious Disease Division, University of Minnesota Medical School, University of Minnesota Medical Center and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, (2)Pharmacy, University of Minnesota Medical Center, MHealth, Minneapolis, MN, (3)Pharmacy, University of Minnesota Medical Center, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, (4)University of Minnesota Medical Center, Minneapolis, MN, (5)Infection Prevention, University of Minnesota Medical Center, Minneapolis, MN


    S. Kline, None

    K. Boeser, None

    P. Phelps, None

    D. England, None

    S. Saunders, None

    K. Lawrence, None

    J. Kanklefitz, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.