The University of Minnesota Medical Center (UMMC) is a tertiary care facility, which has had a comprehensive antimicrobial stewardship program (ASP) for 11 years.
The antimicrobial stewardship team is comprised of a full-time PharmD and ID staff physicians who rotate on the service. 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 2014-2017 with adjustment for change to NHSN lab based surveillance. (Fig.1) From 2009-2017 a decrease was seen in VRE hospital acquired infections (HAI) from 0.53 to 0.24/1000 pt days and in MRSA HAIs from 0.2 to 0.04/1000 pt days. Newly acquired ESBL HAIs have remained relatively stable from 2009-2017 at 0.09 to 0.10/1000 pt days. CRE HAIs are an emerging problem with increasing rates. (Fig. 2)
Cost savings continued from year to year. The greatest cost savings was observed after initial implementation (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 $37.51. Through August 2017, we have observed a sustained average antibiotic cost per patient day of $39.45. (Figure 3.) After adjusting for inflation annually, our expected costs ($70.26) compared to actual costs ($40.39 ytd 2017), demonstrates effective cost management of antimicrobial agents, with saving of ~ $30.00/patient day. (Fig.3)
We observed a decrease in HAIs VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. ESBL HAIs remain relatively stable and CRE are emerging HAIs of concern. Therefore we are now focusing efforts of limiting unneeded carbapenem use. 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 ASP outcomes have continued to cost justify ongoing efforts. The effects of the program and the Infection Prevention Department appear to be synergistic
P. Phelps, None
S. Saunders, None
K. Gand, None
J. Houseman, None
S. Johnson, None
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