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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
*
Address correspondence to Timothy C. Jenkins, MD, 660 Bannock St, Denver, CO 80204 (timothy.jenkins@dhha.org).

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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References

1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Available at: http://www.cdc.gov/drugresistance/threat-report-2013/. Accessed June 9, 2014.Google Scholar
2. President's Council of Advisors on Science and Technology (PCAST). Report to the President on combating antibiotic resisitance. September 2014. Available at: http://m.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf. Accessed November 1, 2014.Google Scholar
3. The White House. National strategy for combating antibiotic-resistant bacteria. September 2014. Available at: http://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf. Accessed November 1, 2014.Google Scholar
4. Magill, SS, Edwards, JR, Beldavs, ZG, et al. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA 2014;312:14381446.Google Scholar
5. Polk, RE, Hohmann, SF, Medvedev, S, et al. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53:11001110.Google Scholar
6. Fridkin, S, Baggs, J, Fagan, R, et al. National Center for Emerging and Zoonotic Infectious Diseases, CDC. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194200.Google Scholar
7. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322327.Google Scholar
8. Doron, S, Nadkarni, L, Lyn Price, L, et al. A nationwide survey of antimicrobial stewardship practices. Clin Ther 2013;35:758765.e720.Google Scholar
9. Newland, JG, Gerber, JS, Weissman, SJ, et al. Prevalence and characteristics of antimicrobial stewardship programs at freestanding children's hospitals in the United States. Infect Control Hosp Epidemiol 2014;35:265271.CrossRefGoogle ScholarPubMed
10. Septimus, EJ, Owens, RC Jr. Need and potential of antimicrobial stewardship in community hospitals. Clin Infect Dis 2011;53:S814.Google Scholar
11. Pakyz, AL, MacDougall, C, Oinonen, M, et al. Trends in antibacterial use in US academic health centers: 2002 to 2006. Arch Intern Med 2008;168:22542260.Google Scholar
12. Gabow, P, Eisert, S, Wright, R. Denver Health: a model for the integration of a public hospital and community health centers. Ann Intern Med 2003;138:143149.Google Scholar
13. Polk, RE, Fox, C, Mahoney, A, et al. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664670.Google Scholar
14. Centers for Disease Control and Prevention: National Healthcare Safety Network. Multidrug-resistant organism & Clostridium difficile infection (MDRO/CDI) module. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf Accessed May 30, 2014.Google Scholar
15. Steinwald, B, Dummit, LA. Hospital case-mix change: sicker patients or DRG creep? Health Aff (Millwood) 1989;8:3547.CrossRefGoogle ScholarPubMed
16. Jump, RL, Olds, DM, Seifi, N, et al. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use. Infect Control Hosp Epidemiol 2012;33:11851192.Google Scholar
17. Nowak, MA, Nelson, RE, Breidenbach, JL, et al. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69:15001508.Google Scholar
18. Carling, P, Fung, T, Killion, A, et al. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24:699706.Google Scholar
19. Mehta, JM, Haynes, K, Wileyto, EP, et al. Comparison of prior authorization and prospective audit with feedback for antimicrobial stewardship. Infect Control Hosp Epidemiol 2014;35:10921099.CrossRefGoogle ScholarPubMed
20. Ruttimann, S, Keck, B, Hartmeier, C, et al. Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clin Infect Dis 2004;38:348356.Google Scholar
21. Pollack, LA, Srinivasan, A. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clin Infect Dis 2014;59:S97100.Google Scholar
22. Standiford, HC, Chan, S, Tripoli, M, et al. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol 2012;33:338345.CrossRefGoogle Scholar
23. Dodds Ashley, ES, Kaye, KS, DePestel, DD, et al. Antimicrobial stewardship: philosophy versus practice. Clin Infect Dis 2014;59:S112S121.Google Scholar
24. Bumpass, JB, McDaneld, PM, DePestel, DD, et al. Outcomes and metrics for antimicrobial stewardship: survey of physicians and pharmacists. Clin Infect Dis 2014;59:S108S111.CrossRefGoogle ScholarPubMed
25. Young, LS, Sabel, AL, Price, CS. Epidemiologic clinical, and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit. Infect Control Hosp Epidemiol 2007;28:12471254.Google Scholar
26. Jenkins, TC, Knepper, BC, Sabel, AL, et al. Decreased antibiotic utilization after implementation of a guideline for inpatient cellulitis and cutaneous abscess. Arch Intern Med 2011;171:10721079.Google Scholar
27. Pakyz, AL, Lee, JA, Ababneh, MA, et al. Fluoroquinolone use and fluoroquinolone-resistant Pseudomonas aeruginosa is declining in US academic medical centre hospitals. J Antimicrob Chemother 2012;67:15621564.Google Scholar
28. Centers for Disease Control and Prevention. Notes from the field: hospital outbreak of carbapenem-resistant Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase--Denver, Colorado, 2012. MMWR Morb Mortal Wkly Rep 2013;62:108.Google Scholar
29. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Eng J Med 2013;368:22552265.Google Scholar
30. Gallini, A, Degris, E, Desplas, M, et al. Influence of fluoroquinolone consumption in inpatients and outpatients on ciprofloxacin-resistant Escherichia coli in a university hospital. J Antimicrob Chemother 2010;65:26502657.Google Scholar
31. Andersson, DI, Hughes, D. Persistence of antibiotic resistance in bacterial populations. FEMS Microbiol Rev 2011;35:901911.Google Scholar
32. Kallen, AJ, Mu, Y, Bulens, S, et al. Health care–associated invasive MRSA infections, 2005–2008. JAMA 2010;304:641648.Google Scholar
33. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:19701978.Google Scholar
34. Valiquette, L, Cossette, B, Garant, MP, et al. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile–associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45:S112S121.Google Scholar
35. Lessa, FC, Gould, CV, McDonald, LC. Current status of Clostridium difficile infection epidemiology. Clin Infect Dis 2012;55:S65S70.Google Scholar
36. Bagdasarian, N, Rao, K, Malani, PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 2015;313:398408.Google Scholar
37. Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42:S82S89.CrossRefGoogle ScholarPubMed
38. Pakyz, A, Carroll, NV, Harpe, SE, et al. Economic impact of Clostridium difficile infection in a multihospital cohort of academic health centers. Pharmacotherapy 2011;31:546551.Google Scholar
39. Ghantoji, SS, Sail, K, Lairson, DR, et al. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 2010;74:309318.Google Scholar
40. DePestel, DD, Eiland, EH 3rd, Lusardi, K, et al. Assessing appropriateness of antimicrobial therapy: in the eye of the interpreter. Clin Infect Dis 2014;59:S154S161.Google Scholar
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