title: Improving antimicrobial use: longitudinal assessment of an antimicrobial team including a clinical pharmacist.
abstract: BACKGROUND
  Inappropriate antimicrobial utilization in hospitalized patients has been associated with adverse effects, emergence of resistant bacteria, and increased health care cost. Participation of clinical pharmacists, working as an integral part of a hospital antimicrobial management team (AMT), has been shown to improve antimicrobial use; however, the long-term impact of such a team on antimicrobial use is unclear.
  
  
  OBJECTIVE
  Our primary objective was to evaluate whether the number of recommendations to improve antimicrobial use made by a hospital AMT decreased over time. Our secondary objective was to identify and evaluate the acceptance of AMT recommendations with respect to the clinical service, site of infection, and category of suboptimal use.
  
  
  METHODS
  We retrospectively reviewed antimicrobial utilization data collected by the team for the 3-year period from July 1996 to June 1999 at the Veterans Affairs Medical Center in Louisville, Kentucky. The total number of antimicrobial treatment episodes and the number of recommendations were grouped into periods of 6 months each during the 3 years. The type of recommendation, type of infection, and clinical service (medicine versus surgery) were reviewed for the entire 3-year period.
  
  
  RESULTS
  The number of antimicrobial treatment episodes for each of the 6-month consecutive periods was 404, 526, 406, 549, 507, and 612. The proportion of episodes requiring team recommendations was constant over the 5 consecutive periods: 39%, 37%, 36%, 36%, 35%, and 37%. (P = 0.8). Acceptance rates of AMT recommendations by the internal medicine and general surgery services remained stable over the length of the study, 84% and 69%, respectively. The distribution of patients treated by the site of infection also remained stable over the study period.
  
  
  CONCLUSIONS
  Our results demonstrate that despite the long-term presence of an AMT, the proportion of antimicrobial episodes requiring intervention and the percentage of accepted recommendations remained constant over a 3-year period. Having new resident physicians in teaching hospitals or staff turnover in managed care organizations may necessitate the continued presence of an active AMT.
authors.affiliation: University of Louisville, Dept. of Medicine, Division of Infections Diseases, 512 S. Hancock St., Carmichael Bldg., Rm. 208E, Louisville, KY 40292, USA. f.arnold@louisville.edu
authors.forename: Forest W
authors.initials: FW
authors.lastname: Arnold
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
authors.forename: David
authors.initials: D
authors.lastname: Newman
authors.forename: R Scott
authors.initials: RS
authors.lastname: Smith
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ramirez
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D007629:Kentucky; D008137:Longitudinal Studies; D010348:Patient Care Team; D010595:Pharmacists; D017410:Practice Guidelines as Topic
chemical_list: D000890:Anti-Infective Agents