Controlling Use of Antimicrobials in a Community Teaching Hospital
- 1 March 2006
- journal article
- Published by Cambridge University Press (CUP) in Infection Control & Hospital Epidemiology
- Vol. 27 (3), 239-244
- https://doi.org/10.1086/500419
Abstract
Objective.: To test the hypothesis that antibiotic use could be controlled or improved in a community teaching hospital, with improvement defined as reductions in overall use, overall cost, and antimicrobial resistance.Design.: Interventional study with historical comparison.Setting.: A not-for-profit, 900-bed community general hospital with residents in medicine, surgery, obstetrics-gynecology, and psychiatry.Participants.: Physicians who requested any of the targeted antibiotics.Interventions.: Three categories of inpatient antibiotic orders were monitored beginning in April 2001: conversion from intravenous to oral administration for selected highly bioavailable antimicrobials, cessation of perioperative prophylaxis within 24 hours for patients undergoing clean and clean-contaminated surgery, and consultation with an infectious diseases physician before continuing administration of selected drugs beyond 48 hours. Data were analyzed after the first 33 months. Patient outcomes were reviewed during the hospital stay and at readmission if it occurred within 30 days after discharge.Results.: From April 2001 through December 2003, a total of 1426 requests for antimicrobial therapy met criteria for intervention. Overall physician compliance with the program was 76%, ranging from 57% for perioperative prophylaxis to 92% for intravenous to oral conversion. Antimicrobial costs per patient-day decreased by 31%, from $13.67 in 2000 (before program implementation) to $9.41 in 2003. Total savings in acquisition costs were $1,841,203 for the 3-year period. Resistance to numerous drugs among Klebsiella pneumoniae isolates was also significantly reduced.Conclusions.: A program to improve the use of antibiotics in a community hospital was successful in reducing overall use, overall cost, and antimicrobial resistance.Keywords
This publication has 16 references indexed in Scilit:
- National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003American Journal of Infection Control, 2003
- Association of Antibiotic Utilization Measures and Control of Multiple-Drug Resistance inKlebsiella pneumoniaeInfection Control & Hospital Epidemiology, 2000
- Guideline for Prevention of Surgical Site Infection, 1999Infection Control & Hospital Epidemiology, 1999
- Preventing the Emergence of Antimicrobial ResistanceJAMA, 1997
- Antibiotic OptimizationArchives of Internal Medicine, 1997
- Effects of Requiring prior Authorization for Selected Antimicrobials: Expenditures, Susceptibilities, and Clinical OutcomesClinical Infectious Diseases, 1997
- Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in HospitalsJama-Journal Of The American Medical Association, 1996
- Influence of Blood Culture Results on Antibiotic Choice in the Treatment of BacteremiaArchives of Internal Medicine, 1994
- Antimicrobial misuse in patients with positive blood culturesAmerican Journal Of Medicine, 1989
- From the Infectious Diseases Society of America Guidelines for Improving the Use of Antimicrobial Agents in Hospitals: A Statement by the Infectious Diseases Society of AmericaThe Journal of Infectious Diseases, 1988