title: Clinical and economic outcomes from a community hospital's antimicrobial stewardship program.
abstract: BACKGROUND
  Data from community antimicrobial stewardship programs (ASPs) are limited. We describe clinical and economic outcomes from the first year of our hospital's ASP.
  
  
  METHODS
  The ASP team comprised 2 infectious disease physicians and 3 intensive care unit pharmacists. The team prospectively audited the new starts and weekly use of 8 target antimicrobials: aztreonam, caspofungin, daptomycin, ertapenem, linezolid, meropenem, tigecycline, and voriconazole. Using administrative data, outcomes from the first year of the program, including death within 30 days of hospitalization, readmission within 30 days of discharge, and development of Clostridium difficile infection (CDI), were compared with outcomes from a similar period before institution of the program.
  
  
  RESULTS
  A total of 510 antimicrobial orders were reviewed, of which 323 (63%) were appropriate, 94 (18%) prompted deescalation, 61 (12%) were denied, and 27 (5%) led to formal consultation with an infectious disease physician. On multivariate analysis, implementation of the ASP was associated with an approximate 50% reduction in the odds of developing CDI (odds ratio, 0.46; 95% confidence interval, 0.25-0.82). The ASP was not associated with decreased mortality at 30 days after discharge or readmission rate. The antimicrobial cost per patient-day decreased by 13.3%, from $10.16 to $8.81. The antimicrobial budget decreased by 15.2%, resulting in a total savings of $228,911. There was a 25.4% decrease in defined daily doses of the target antimicrobials.
  
  
  CONCLUSIONS
  Implementation of the ASP was associated with significant reductions in CDI rate, antimicrobial use, and pharmacy costs.
authors.affiliation: Department of Internal Medicine, Saint Joseph Mercy Health System, Ann Arbor, MI, USA. malanian@umich.edu
authors.forename: Anurag N
authors.initials: AN
authors.lastname: Malani
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Richards
authors.forename: Shikha
authors.initials: S
authors.lastname: Kapila
authors.forename: Michael H
authors.initials: MH
authors.lastname: Otto
authors.forename: Jennifer
authors.initials: J
authors.lastname: Czerwinski
authors.forename: Bonita
authors.initials: B
authors.lastname: Singal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D001424:Bacterial Infections / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents