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

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 525-bed public safety-net hospital 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 1000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset C. 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/1000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1000 PD, respectively), resulting in a slope change of 5.5 DOT/1000 PD per quarter for total antibacterial use (P = .10) and 3.3 DOT/100 PD per quarter for antipseudomonal use (P = .01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1000PD 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; however, this study highlights limitations of commonly used stewardship outcome measures.

Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

“…Hospitals with relatively low baseline rates of CDI did not see a substantial change after deployment of an ASP. 14,15 …”

The impact of earlier intervention by an antimicrobial stewardship team for specific antimicrobials in a single weekly intervention

“…The possibility that fluctuation of antimicrobial resistance rates could be influenced by many more factors, including infection control, rather than by decreased antimicrobial use alone, should also be taken into consideration. Although reports have shown the decreasing use of antimicrobials and cost reductions as a result of once a week intervention (Fukuda et al, 2014;Jenkins et al, 2015;Tagashira et al, 2016), more appropriate timing of intervention by PAF to enhance the effects of the AST, or the problem of the labor burden and manpower, remain the subject for further study.…”

Long-term efficacy of comprehensive multidisciplinary antibiotic stewardship programs centered on weekly prospective audit and feedback

“…In the guidelines for implementing ASPs, a core strategy is prospective audit and feedback (PAF) [9][10]. Many studies have verified the efficacy of this approach for correcting antibiotic-prescribing patterns, reducing administration of broad-spectrum antibiotics, decreasing Clostridium(Clostridioides)difficile infection (CDI), and suppressing the emergence of resistant bacteria [15][16][17][18][19][20][21][22][23][24]. However, PAF is very labor-intensive, so its effectiveness depends on adequate institutional resources [10].…”

“…However, PAF is very labor-intensive, so its effectiveness depends on adequate institutional resources [10]. Moreover, few reports have demonstrated its long-term effects [15,[20][21][22][23]. While many studies of ASPs have been reported in the Asia Pacific region, high-quality studies using standardized surveillance methodology are needed in this area [25].…”