title: Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention.
abstract: OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014. METHODS Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents. RESULTS A total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care. CONCLUSION Antimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials. Infect Control Hosp Epidemiol 2017;38:259-265.
authors.affiliation: 1Department of Pharmacy,UW Health,Madison,Wisconsin.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dela-Pena
authors.affiliation: 1Department of Pharmacy,UW Health,Madison,Wisconsin.
authors.forename: Luiza
authors.initials: L
authors.lastname: Kerstenetzky
authors.affiliation: 1Department of Pharmacy,UW Health,Madison,Wisconsin.
authors.forename: Lucas
authors.initials: L
authors.lastname: Schulz
authors.affiliation: 1Department of Pharmacy,UW Health,Madison,Wisconsin.
authors.forename: Ron
authors.initials: R
authors.lastname: Kendall
authors.affiliation: 2Division of Infectious Diseases,Department of Medicine,UW Health,Madison,Wisconsin.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lepak
authors.affiliation: 2Division of Infectious Diseases,Department of Medicine,UW Health,Madison,Wisconsin.
authors.forename: Barry
authors.initials: B
authors.lastname: Fox
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000191:economics*; D000073602:Antimicrobial Stewardship / Q000191:economics*; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014922:Wisconsin
chemical_list: D000890:Anti-Infective Agents