title: A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative.
abstract: OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.
authors.affiliation: 1National Infectious Diseases Service,Veterans Health Administration,Washington,DC.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Kelly
authors.affiliation: 4IDEAS Center,Salt Lake City Veterans Affairs Medical Center,Salt Lake City,Utah.
authors.forename: Makoto M
authors.initials: MM
authors.lastname: Jones
authors.affiliation: 6South Texas Veterans Healthcare System,San Antonio,Texas.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Echevarria
authors.affiliation: 1National Infectious Diseases Service,Veterans Health Administration,Washington,DC.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kralovic
authors.affiliation: 4IDEAS Center,Salt Lake City Veterans Affairs Medical Center,Salt Lake City,Utah.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.affiliation: 9Veterans Affairs Greater Los Angeles Healthcare System,Los Angeles,California.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: 11Boise Veterans Affairs Medical Center,Boise,Idaho.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Madaras-Kelly
authors.affiliation: 1National Infectious Diseases Service,Veterans Health Administration,Washington,DC.
authors.forename: Loretta A
authors.initials: LA
authors.lastname: Simbartl
authors.affiliation: 13Pharmacy Benefits Management Services,Veterans Health Administration,Washington,DC.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Morreale
authors.affiliation: 14Pharmacy Benefits Management Services,Veterans Health Administration,Hines,Illinois.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Neuhauser
authors.affiliation: 1National Infectious Diseases Service,Veterans Health Administration,Washington,DC.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Roselle
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents