title: Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.
abstract: OBJECTIVE
  To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years.
  
  
  METHODS
  Prospective study with comparison with preintervention trends.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  All adult inpatients.
  
  
  METHODS
  A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size.
  
  
  RESULTS
  Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P = .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates.
  
  
  CONCLUSIONS
  These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002511:Cephalosporins / Q000191:economics / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects* / Q000472:pathogenicity*; D003428:Cross Infection; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000472:pathogenicity; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000191:economics / Q000635:transmission; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016106:Methicillin Resistance; D010348:Patient Care Team; D011159:Population Surveillance; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins