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Published on: April 18, 2019
Results of an antimicrobial control program at a university hospital
Craig Martin1, Ighovwerha Ofotokun, Robert Rapp
1University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA. cmart2@email.uky.edu
Purpose:
The results of the first five years of an ongoing antimicrobial control program are reported.
Methods:
In 1998, a multidisciplinary antimicrobial subcommittee of the pharmacy and therapeutics committee of a university hospital was formed and charged with making formulary interventions in an effort to reduce rising antimicrobial resistance rates and drug expenditures. In 1999, a number of measures were implemented for controlling antimicrobial use. Selected antimicrobials with the potential for inappropriate use or whose inappropriate use had been documented were placed in the control of physicians in the infectious diseases (ID) division. Prior approval by an ID physician was required before the pharmacy could dispense these agents. Other key interventions included removal of ceftazidime and cefotaxime from the formulary, restriction of vancomycin and carbapenem use, and replacement of ciprofloxacin with levofloxacin as the sole fluoroquinolone on the formulary. Data regarding antimicrobial use and expenditures between 1998 and 2002 were compared and analyzed.
Results:
Antimicrobial use was reduced by 80% for third-generation cephalosporins and 15% for vancomycin following the implementation of the new antimicrobial policies. Antimicrobial-resistance patterns for many important gram-negative pathogens, including Pseudomonas aeruginosa, demonstrated a reversal of previous increases. In addition, the rate of methicillin-resistant Staphylococcus aureus decreased by an average of 3% each year from 1999 to 2002. Pharmacy expenditures for all antimicrobials, including antiviral, antifungal, and antibacterial agents, decreased 24.7%, with a cumulative cost saving of 1,401,126 US dollars, without inflation assumptions.
Conclusion:
The implementation of an antimicrobial control program decreased the use of selected antimicrobial agents and resulted in substantial reduction of expenditures for antimicrobials.
Insights
An antimicrobial control program significantly reduced antimicrobial use and expenditures. This initiative successfully lowered resistance rates for key pathogens and resulted in over $1.4 million in savings.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Antimicrobial Stewardship
Background:
- Rising antimicrobial resistance rates and escalating drug expenditures pose significant challenges in healthcare settings.
- Effective antimicrobial stewardship programs are crucial for combating resistance and optimizing resource allocation.
Purpose of the Study:
- To report the outcomes of a comprehensive antimicrobial control program implemented over five years.
- To evaluate the program's impact on antimicrobial resistance patterns and associated costs.
Main Methods:
- Formation of a multidisciplinary antimicrobial subcommittee to guide formulary interventions.
- Implementation of restricted access for specific antimicrobials, requiring infectious diseases (ID) physician approval.
- Strategic formulary adjustments, including agent removal and replacement, to guide appropriate use.
Main Results:
- An 80% reduction in third-generation cephalosporin use and a 15% decrease in vancomycin use were observed.
- Reversal of increasing resistance trends for key gram-negative pathogens like Pseudomonas aeruginosa.
- An average annual decrease of 3% in methicillin-resistant Staphylococcus aureus rates and a 24.7% overall reduction in pharmacy expenditures for antimicrobials, totaling over $1.4 million in savings.
Conclusions:
- The implemented antimicrobial control program effectively reduced the utilization of targeted antimicrobial agents.
- The program led to substantial cost savings in antimicrobial expenditures without compromising patient care.
