title: Impact of an antimicrobial stewardship program on patients with acute bacterial skin and skin structure infections.
abstract: OBJECTIVE
  The impact of an antimicrobial stewardship program (ASP) on the management of therapy and hospital resources for patients with acute bacterial skin and skin structure infections (ABSSSIs) at a community teaching hospital was evaluated.
  
  
  METHODS
  A retrospective, observational chart review was performed to evaluate the impact of the ASP on patients admitted to Akron City Hospital with a diagnosis of ABSSSI between February 1 and August 20, 2012. Information on patient demographic characteristics, comorbidities, ABSSSI subtype, antibiotic therapy, microbiology, surgical interventions, and ASP recommendations was collected from medical records and the ASP intervention log. ASP recommendations were organized into five categories: dosage changes, de-escalation, antibiotic regimen change (i.e., change antibiotic regimen to a broad-spectrum antimicrobial or target a pathogen not being covered), infectious diseases (ID) formal consultation, and other.
  
  
  RESULTS
  A total of 62 patients were included in the study. A total of 85 recommendations were made to attending physicians for these 62 patients, with an acceptance rate of 95%. The most common interventions included dosage changes, de-escalation, antibiotic regimen change, and ID consultation. When compared with historical data for 1149 patients, the intervention group had a significantly lower mean length of stay (LOS). The 30-day all-cause readmission rate was also significantly lower in the intervention group; however, the 30-day ABSSSI readmission rate did not differ significantly between groups.
  
  
  CONCLUSIONS
  Interventions made by an ASP including a clinical pharmacist were associated with significant reductions in the mean LOS and 30-day all-cause readmission rate for patients with an ABSSSI compared with historical data.
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron. timothy.pasquale@carolinashealthcare.org.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Pasquale
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Tamara L
authors.initials: TL
authors.lastname: Trienski
authors.forename: Deanna E
authors.initials: DE
authors.lastname: Olexia
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Deana E
authors.initials: DE
authors.lastname: Olexia
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Myers
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tan
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Leung
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Poblete
authors.affiliation: Timothy R. Pasquale, Pharm.D., M.B.A., is Infectious Disease Clinical Specialist, Carolinas Healthcare System, Carolinas Medical Center, Charlotte, NC. Tamara L. Trienski, Pharm.D., is Clinical Lead Pharmacist, Antimicrobial Stewardship; and Deana E. Olexia, Pharm.D., is Clinical Staff Pharmacist, Summa Health System, Akron City Hospital, Akron, OH. Joseph P. Myers, M.D., is Vice President of Medical Affairs, Southwest Region, Summa Health System, Summa Barberton Hospital, Barberton, OH. Michael J. Tan, M.D., is Infectious Disease Physician; Anthony K. Leung, D.O., is Infectious Disease Physician; Jose E. Poblete, M.D., is Infectious Disease Physician; and Thomas M. File Jr., M.D., is Infectious Disease Physician, Summa Health System, Akron.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: File
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial / Q000187:drug effects / Q000502:physiology; D005260:Female; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents