Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use.
OBJECTIVE
To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use.


METHODS
Quasi-experimental, interrupted time-series study.


METHODS
Public safety net hospital with 525 beds.


METHODS
Implementation of a formal ASP in July 2008.


METHODS
We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008-September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005-June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures.


RESULTS
During the preintervention period, total antibacterial and antipseudomonal use were declining (-9.2 and -5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (-3.7 and -2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (-$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes.


CONCLUSIONS
In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.
1Department of Medicine.
Timothy C
TC
Jenkins
3Department of Patient Safety and Quality.
Bryan C
BC
Knepper
4Department of Pharmacy.
Katherine
K
Shihadeh
1Department of Medicine.
Michelle K
MK
Haas
3Department of Patient Safety and Quality.
Allison L
AL
Sabel
1Department of Medicine.
Andrew W
AW
Steele
6Department of Pathology and Laboratory Services,Denver Health,Denver,Colorado.
Michael L
ML
Wilson
1Department of Medicine.
Connie S
CS
Price
1Department of Medicine.
William J
WJ
Burman
1Department of Medicine.
Philip S
PS
Mehler
D000890:Anti-Infective Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D003120:Colorado; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D054539:Medication Therapy Management / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation / Q000379:methods; D017751:Safety Management; D013995:Time
D000890:Anti-Infective Agents