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Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

Published online by Cambridge University Press:  05 March 2015

Timothy C. Jenkins
Affiliation:
Department of Medicine Division of Infectious Diseases Department of Medicine Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Bryan C. Knepper
Affiliation:
Department of Patient Safety and Quality
Katherine Shihadeh
Affiliation:
Department of Pharmacy
Michelle K. Haas
Affiliation:
Department of Medicine Division of Infectious Diseases Department of Medicine Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Allison L. Sabel
Affiliation:
Department of Patient Safety and Quality Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
Andrew W. Steele
Affiliation:
Department of Medicine eHealth Services Department of Medicine
Michael L. Wilson
Affiliation:
Department of Pathology and Laboratory Services, Denver Health, Denver, Colorado
Connie S. Price
Affiliation:
Department of Medicine Division of Infectious Diseases Department of Medicine Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
William J. Burman
Affiliation:
Department of Medicine Division of Infectious Diseases Department of Medicine Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Philip S. Mehler
Affiliation:
Department of Medicine Division of Infectious Diseases Department of Patient Safety and Quality Department of Medicine Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
Corresponding
E-mail address:

Abstract

OBJECTIVE

To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use.

DESIGN

Quasi-experimental, interrupted time-series study.

SETTING

Public safety net hospital with 525 beds.

INTERVENTION

Implementation of a formal ASP in July 2008.

METHODS

We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008–September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005–June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures.

RESULTS

During the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes.

CONCLUSION

In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.

Infect Control Hosp Epidemiol 2015;00(0): 1–9

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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