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[Evaluation of an advisory program in antibiotic therapy]
J Cobo Reinoso1, J Oliva Domínguez, M Soler Vigil
1Servicios de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain. jcobo@hrc.insalud.es
Background:
Increases in microbial resistance and pharmaceutical costs have prompted an interest in antibiotic control programs (ACP). Nevertheless, there is controversy on the optimal ACP design and implementation. An ACP based on the infectious diseases' specialist recommendations was evaluated.
Methods:
Interventional study of two hospital departments (medical and surgical). Antibiotic costs, mortality rate, readmissions following an infectious disease, and incidence of MRSA and Clostridium difficile between the intervention period and the same period in the previous year were compared. An anonymous survey among health care workers in both departments was conducted.
Results:
One-hundred and one antimicrobial therapy courses administered to 80 patients were evaluated. A total of 77 recommendations were issued, which consisted of therapy discontinuation (39%), switch to oral antibiotics (31%), decrease in the antimicrobial spectrum (24%) or enhancing the antimicrobial spectrum (6%). Eighty-five percent of the recommendations were accepted. The antimicrobial use remained stabilized, but the oral administration increased from 12.5 to 18.6 DDD/100 patient-days and parenteral use decreased from 25.9 to 22.3 DDD/100 patient-days. Antimicrobial costs decreased by 19.4% (901,794 pesetas). No changes, either in the mortality rate or in readmission rate due to infectious diseases was observed. In contrast, a decrease in the incidence of both MRSA (3.7% to 0.8%; p < 0.05) and Clostridium difficile (1.2% to 0%; p = 0.05) was observed. All health care workers that responded to the survey thought that ACP should be extended to the rest of the hospital.
Conclusions:
Our ACP, based on the advice of an infectious diseases specialist, was very well accepted and allows for a decrease in antibiotic costs by simplified therapy. The ACP did not cause a negative impact on patients' outcomes and would probably help reducing the incidence of some nosocomial pathogens.
Insights
An antibiotic control program (ACP) guided by infectious disease specialists effectively reduced antibiotic costs and the incidence of hospital-acquired infections like MRSA and Clostridium difficile. This program demonstrated positive outcomes without negatively impacting patient mortality or readmission rates.
Area of Science:
- Infectious Diseases
- Hospital Administration
- Antimicrobial Stewardship
Context:
- Rising microbial resistance and escalating pharmaceutical costs necessitate effective antibiotic control programs (ACPs).
- Optimal design and implementation of ACPs remain subjects of debate within healthcare settings.
- This study evaluated an ACP based on infectious diseases specialist recommendations.
Purpose:
- To assess the impact of an infectious diseases specialist-driven ACP on antibiotic costs, patient outcomes, and the incidence of specific nosocomial pathogens.
- To evaluate the acceptance and feasibility of implementing an ACP in hospital departments.
Summary:
- An interventional study in two hospital departments compared an ACP period with the previous year, analyzing antibiotic costs, mortality, readmissions, and incidence of MRSA and Clostridium difficile.
- The ACP involved 77 recommendations, with 85% acceptance, leading to stabilized antimicrobial use but increased oral and decreased parenteral administration.
- Significant findings include a 19.4% decrease in antimicrobial costs and a reduction in MRSA and Clostridium difficile incidence, with no adverse effects on mortality or readmission rates.
Impact:
- The implemented ACP, guided by infectious diseases specialists, was well-accepted by healthcare workers and led to reduced antibiotic expenditures through simplified therapy.
- The program did not negatively affect patient outcomes, suggesting its potential to decrease the incidence of certain nosocomial pathogens.
- Survey results indicated strong support among healthcare workers for extending the ACP to other hospital areas.