Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.
OBJECTIVE
To evaluate changes in antimicrobial use and expenditures and the rates of selected nosocomial infections due to resistant organisms associated with implementation of an antimicrobial-prescribing improvement program.


METHODS
Before-after trial comparing 1992 (pre-program), 1993 (a transition year), and 1994 (after full implementation of the program).


METHODS
Academic medical center, all patients and physicians.


METHODS
An antimicrobial-prescribing improvement program with prior approval requirement for use of restricted agents.


METHODS
Antimicrobial use and expenditures, rates of selected nosocomial infection marker events.


RESULTS
Between 1992 and 1994, there were substantial decreases in antimicrobial use, from 158,107 to 137,364 defined daily doses, and in expenditures from $2,486,902 ($24.01 per patient day) to $1,701,522 ($18.49 per patient day). After adjusting for changes in purchase prices and census days, we estimated savings attributable to the program of $279,573 in 1993 and $389,814 in 1994. In addition, we found significant decreases between 1992 and 1994 in the rates of enterococcal bacteremia (.34 vs .16 events per 1,000 patient days; P = .016), selected gram-negative bacteremia (.26 vs .11; P = .015), methicillin-resistant Staphylococcus aureus colonization or infection (.66 vs .20; P < .0001), and Stenotrophomonas colonization or infection (.35 vs .17; P = .019). No significant change occurred in rates of nosocomial candidemia or Clostridium difficile toxin-positive diarrhea. Values for 1993 were intermediate between those of 1992 and 1994.


CONCLUSIONS
Implementation of an antimicrobial-prescribing improvement program was associated with substantial savings in antimicrobial use and expenditures and significant decreases in rates of selected nosocomial infections due to resistant organisms.
Frank
M O
MO
Indiana University School of Medicine, Indianapolis 46202, USA.
Batteiger
B E
BE
Sorensen
S J
SJ
Hartstein
A I
AI
Carr
J A
JA
McComb
J S
JS
Clark
C D
CD
Abel
S R
SR
Mikuta
J M
JM
Jones
R B
RB
D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D003363:Cost Control; D019091:Critical Pathways; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D016527:Drug Costs / Q000706:statistics & numerical data / Q000639:trends; D017723:Drug Utilization Review; D006745:Hospital Bed Capacity, 300 to 499; D006785:Hospitals, University / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007902:Length of Stay; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods; D012720:Severity of Illness Index