Background: Establishing antimicrobial stewardship programs (ASP) in community hospitals with limited resources can be challenging. Many hospitals do not have infectious disease (ID) trained pharmacists (PharmD) available. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback at an urban community hospital.
Methods: ASP was implemented at a 151-bed urban community hospital in October 2017. PharmD training on syndrome-based treatment guidelines, including definitions, severity, empiric regimens, de-escalation and duration was created. Prospective audit by PharmDs was established. This program was implemented and overseen by an ID physician. Days of therapy per 1000 patient days (DOT/1000) was assessed 3 months before and after ASP. Prospective audit and feedback data was reviewed.
Results: At 3 months, antimicrobial use decreased (370 vs 350 DOT/1000) while the proportion of oral antimicrobials used increased (32% vs 43%). Antibiotic expenditures decreased by 11% ($42,500 vs $37,900). Most cases reviewed by prospective audit (58%) fit pre-determined syndromes (Figure 1). Soft tissue and urinary tract infections were the most common syndromes. Interventions occurred in 53% of cases. De-escalation from broad-spectrum agents was more successful in non-critical care settings (Figure 2).
Figure 1. ASP syndrome-based prospective audit and feedback
Figure 2. Antimicrobial use in medical surgical units after implementation of ASP
Conclusion: Syndrome-based prospective audit and feedback was successfully implemented in an urban community hospital with non-ID trained PharmDs using ID physician leadership. Our program led to a decrease in antibiotic use, increase use of oral alternatives, and decreased antibiotic expenditures. Empiric use of broad-spectrum agents was common at our facility. ASP likely contributed to an increase in ceftriaxone and decrease in piperacillin-tazobactam use in medical-surgical floors. Stewardship in critically ill patients remains a challenge. Clear guidelines and access to an ID physician are necessary to provide adequate support for PharmDs without ID-specific training and can help curb antibiotic use. Expanding the list of syndromes may further impact antimicrobial use.
A. J. Mena Lora,
R. Chu, None
E. Li, None
S. Borgetti, None
Y. Coleman, None
S. Spencer, None
C. Krill, None
E. Takhsh, None
S. C. Bleasdale, None
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