Implementation and Outcome Assessment of an Inpatient Antimicrobial Stewardship Program

Abstract

Background An antimicrobial stewardship program (ASP), aiming to optimize antimicrobial usage, was implemented at a Veterans Affairs Health Care System (VA HCS). Objective The main objective of this study was to compare antimicrobial usage before and after implementation of an ASP and to assess ASP interventions. Method This retrospective study was conducted at the Fargo VA HCS. A total of 1,017 inpatient charts were reviewed for 2 distinct time periods, February through September 2008 (pre ASP) and February through September 2010 (post ASP). The data that were collected and analyzed included the number of hospitalized patients prescribed antimicrobials, antimicrobial therapy duration, duration of hospital stay, and inpatient antimicrobial costs. Subgroup analyses were performed on the top 5 antimicrobials and the top 6 indications. The number, types of, and overall acceptance rate of ASP interventions were also assessed. Results When the pre- to post-ASP periods were compared, the percentage of patients on antimicrobial therapy decreased from 36.8% to 25% (P < .001), the median duration of antimicrobial therapy significantly decreased (P = .02), and the defined daily dose (DDD) per 1,000 patient bed days was reduced for piperacillin/tazobactam, vancomycin, and ciprofloxacin. In addition, the total inpatient antimicrobial costs decreased by $48,044 (25%). The overall ASP intervention acceptance rate was 81.6% (315 out of 386 total interventions). Conclusion The results of this study show that ASP implementation has been highly accepted by providers and has been associated with a reduction in the number of patients prescribed antimicrobials, median duration of antimicrobial therapy, and antimicrobial inpatient costs.

A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

“…The majority of the studies that reported significant cost savings did not provide the cost of implementing the program. Table 2 summarizes studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] that assessed the impact of ASP on antimicrobial use and cost of antimicrobials.…”

The need for cost-effectiveness analyses of antimicrobial stewardship programmes: A structured review

“…conversion (1). Of the 36 included studies, 2 were full CEAs [13,14]; 27 studies reported changes to costs and health outcomes separately [3,5,[8][9][10][12][13][14][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and 9 reported only changes to costs [4,6,[15][16][17][18][19][20][21]. Table 1 presents the methods and results for studies that measured only cost outcomes and Table 2 presents the methods and findings of those studies that measured both a clinical as well as a cost outcome.…”

“…PAIF was the most commonly evaluated strategy (12/27; 44%) [3,8,10,13,[22][23][24][25][26][27][28]30]. In these 12 studies, the clinical outcomes measured ranged from LOS (6/12), mortality (6/12), presence of multiresistant organisms (3/12), C. difficile infection (CDI) rates (5/12) and 30-day re-admission rates (1/12).…”

“…Of the 12 studies, 8 were from the USA, 2 from Japan and 1 each were from Israel and Canada. Eleven of the twelve studies reported a reduction in TAE and cost savings [3,8,10,13,[22][23][24][26][27][28]30], but one reported a loss of $215.99 [25]. One study also noted cost savings associated with the reduction in LOS [10].…”

“…One study also noted cost savings associated with the reduction in LOS [10]. Ten of the twelve studies reported the TAE [3,8,10,22,23,25,26,[28][29][30], whilst one study reported TAE per admission [24] and one reported findings as TAE per 1000 PDs [27]. One study also specifically mentioned that a saving of $194 160 [3] was achieved by i.v.-to-p.o.…”