Impact of a hospital-based antimicrobial management program on clinical and economic outcomes.
Inappropriate use of antimicrobial agents results in unnecessary exposure to medication, persistent or progressive infection, emergence of resistance, and increased costs. We implemented a program to control use of restricted agents while improving care. This study compared 2 major mechanisms for improving use of antimicrobial agents: (1) recommendations made by the Antimicrobial Management Team (AMT), which included a clinical pharmacist backed up by a physician from the Division of Infectious Diseases (ID), and (2) recommendations made by ID fellows. Outcome measures included appropriateness of recommendations, cure rate, number of treatment failures, and cost of care, which were assessed for 180 patients. The AMT outperformed the ID fellows in all outcomes examined by the study (including appropriateness [87% vs. 47%; P<.001], cure rate [64% vs. 42%; P=.007], and treatment failures [15% vs. 28%; P=.03]), although the differences in economic outcomes between cases managed by the AMT and those managed by the ID fellows were not statistically significant. In an academic setting with a restricted formulary, the AMT demonstrated better antimicrobial prescribing than ID fellows.
Gross
R
R
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, 423 Guardian Dr., Philadelphia, PA 19104, USA. rgross@cceb.med.upenn.edu
Morgan
A S
AS
Kinky
D E
DE
Weiner
M
M
Gibson
G A
GA
Fishman
N O
NO
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy* / Q000191:economics; D017723:Drug Utilization Review; D005260:Female; D017721:Hospital Costs; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000592:standards*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018709:Statistics, Nonparametric; D014481:United States
D000900:Anti-Bacterial Agents