title: Establishing a hospital program to improve antimicrobial use, control bacterial resistance and contain healthcare costs: the University of Louisville experience.
abstract: Antimicrobials have been used in excess for decades. As a result, antimicrobial resistance and cost have increased. In response to this growing national problem, hospital antimicrobial teams were recom-mended in 1988, but few institutions have invested in comprehensive, interdisciplinary programs. The division of infectious diseases at the University of Louisville School of Medicine was a leader in 1990 by establishing an antimicrobial team at the University of Louisville Hospital and Veterans Affairs Hospital. This manuscript reviews the activities of the antimicrobial teams to create antimicrobial guidelines, evaluate antimicrobial use, and provide feedback to physicians. It also summarizes the successful impact the teams have had on optimizing antimicrobial use in the hospital by improving compliance with the guidelines, controlling resistant organisms, and preventing escalation of antimicrobial cost over the years.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville, KY 40202, USA. F.Arnold@louisville.edu
authors.forename: Forest W
authors.initials: FW
authors.lastname: Arnold
authors.forename: Alpa
authors.initials: A
authors.lastname: Patel
authors.forename: Raul
authors.initials: R
authors.lastname: Nakamatsu
authors.forename: R Scott
authors.initials: RS
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Newman
authors.forename: Carmen V
authors.initials: CV
authors.lastname: Sciortino
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.forename: James
authors.initials: J
authors.lastname: Snyder
authors.forename: Paul
authors.initials: P
authors.lastname: Schulz
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ramirez
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review / Q000458:organization & administration*; D005572:Formularies, Hospital as Topic; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006300:Health Services Misuse; D006785:Hospitals, University / Q000458:organization & administration*; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007629:Kentucky; D007857:Leadership; D010348:Patient Care Team; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D016730:Program Development / Q000379:methods*; D012308:Risk Management
chemical_list: D000890:Anti-Infective Agents