title: Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan.
abstract: BACKGROUND
  Reports of antimicrobial stewardship programs (ASPs) in community hospitals are limited, with the major focus on specific agents, small settings, or short time periods. Here we present the outcomes of cost control, consumption restraint, and quality of care after a 3-year multidisciplinary ASP in a 415-bed community public teaching hospital.
  
  
  METHODS
  Three strategies for improving antimicrobial stewardship were implemented: education, clinical pharmacists-based intervention, and regular outcome announcement. The steering panel of the program was a committee composed of infection specialists, attending physicians, clinical pharmacists, nurses, and medical laboratorists.
  
  
  RESULTS
  Semiannual data from July 2009 to June 2012 was analyzed. Antibiotic costs declined from $21,464 to $12,146 per 1,000 patient-days (-43.4%). Approximately $2.5 million was saved in 3 years, and estimated labor cost was $3,935 per month. Defined daily dose per 1,000 patient-days were diminished from 906.7 to 717.5 (-20.9%). Significant reductions were found in the consumption of aminoglycosides, first-generation cephalosporins, and aminopenicillins. However, through comprehensive auditing, increasing consumption of fourth-generation cephalosporins and fluoroquinolones was noticed. No significant difference in the quality of care (ie, length of stay, incidence of health care associated infections, and mortality) was observed.
  
  
  CONCLUSIONS
  The multidisciplinary ASP was beneficial to reduce antibiotic cost and consumption. The strategies were practical and worthy to be recommended to community health care settings.
authors.affiliation: Department of Pharmacy, Taipei City Hospital Yang-Ming Branch, Taipei City Government, Taipei, Taiwan.
authors.forename: Yu-Shiuan
authors.initials: YS
authors.lastname: Lin
authors.forename: I-Fen
authors.initials: IF
authors.lastname: Lin
authors.forename: Yung-Feng
authors.initials: YF
authors.lastname: Yen
authors.forename: Pei-Ching
authors.initials: PC
authors.lastname: Lin
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Shiu
authors.forename: Hsing-Yi
authors.initials: HY
authors.lastname: Hu
authors.forename: Ying-Pi
authors.initials: YP
authors.lastname: Yang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000191:economics / Q000592:standards*; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D033183:Interdisciplinary Communication; D013624:Taiwan
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clinical pharmacists; Cost-benefit; Drug utilization evaluation; Education; Feedback; Multidisciplinary; Program development