Antimicrobial stewardship in a community hospital: attacking the more difficult problems

Area of Science:

• Infectious Diseases
• Health Informatics
• Pharmacoeconomics

Background:

• Antibiotic stewardship programs aim to combat antibiotic resistance.
• A community hospital's program, initiated in 2001, successfully reduced antimicrobial use and expenditure.
• In 2011, a data-mining tool enhanced the program, shifting focus to judicious prescribing.

Purpose of the Study:

• To evaluate if a data-mining tool improves an existing antimicrobial stewardship program.
• To test the hypothesis that enhanced tools increase appropriate antimicrobial use.

Main Methods:

• An interventional study with historical comparison was conducted.
• A data-mining tool with built-in alerts identified inappropriate antibiotic use.
• Pharmacists and physicians intervened on alerts regarding IV-to-oral conversion, antibiotic duration, restricted agents, de-escalation, and bug-drug mismatch.

Main Results:

• In 2012, 2,003 interventions were made with a 90% acceptance rate.
• Broad-spectrum antibiotic use decreased by 15% in 2012 versus 2010, saving $1,621,730.
• No significant changes in antimicrobial resistance or adverse patient outcomes were observed.

Conclusions:

• Data-mining tools enhance antimicrobial stewardship programs.
• These tools reduce inappropriate antibiotic use and increase cost savings.
• Enhanced programs improve antimicrobial use without adverse patient outcomes.