Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-28T20:04:04.262Z Has data issue: false hasContentIssue false

Controlling Use of Antimicrobials in a Community Teaching Hospital

Published online by Cambridge University Press:  21 June 2016

Carla Philmon*
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
Terri Smith
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
Sharon Williamson
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
Edward Goodman
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
*
Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231 (carlaphilmon@texashealth.org)

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McGowan, JE, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997; 11:297311.CrossRefGoogle ScholarPubMed
2.Schwartz, B, Bell, DM, Hughes, JM. Preventing the emergence of antimicrobial resistance: a call for action by clinicians, public health officials, and patients. JAMA 1997; 278:944945.Google Scholar
3.Fraser, GL, Stogsdill, P, Dickens, JD, et al. Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1997; 157:16891694.CrossRefGoogle ScholarPubMed
4.Pelletier, LL. Hospital usage of parenteral antimicrobial agents: a gradated utilization review and cost containment program. Infect Control 1985; 6:226230.Google Scholar
5.Marr, JJ, Moffet, HL, Kunin, CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 1988; 157:869876.Google Scholar
6.Dunagan, WC, Woodward, RS, Medoff, G, et al. Antimicrobial misuse in patients with positive blood cultures. Am J Med 1989; 87:253259.Google Scholar
7.McGowan, JE. Do intensive antibiotic control programs prevent the spread of antibiotic resistance? Infect Control Hosp Epidemiol 1994; 15: 478483.Google Scholar
8.Arbo, MD, Snydman, DR. Influence of blood culture results on antibiotic choice in the treatment of bacteremia. Arch Intern Med 1994; 154:26412645.CrossRefGoogle ScholarPubMed
9.Goldmann, DA, Weinstein, RA, Wenzel, RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 1996; 275:234240.Google Scholar
10.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-sensitive Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999; 20:408411.Google Scholar
11.Shlaes, DM, Gerding, DN, John, JF, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 1997; 25:584599.Google Scholar
12.Patterson, JE, Hardin, TC, Kelly, CA, et al. Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2000; 21:455458.Google Scholar
13.White, AC, Atmar, RL, Wilson, J, et al. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997; 25:230239.Google Scholar
14.Smith, DW, Decreased antimicrobial resistance after changes in antibiotic use. Pharmacotherapy 1999; 19(8 pt 2):129S132S.CrossRefGoogle ScholarPubMed
15.Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 2001; 43:9297.Google Scholar
16.American Society of Health-System Pharmacists. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. Am J Health Syst Pharm 1999; 56:18391888.Google Scholar
17.Mangram, AJ, Horan, TC, Pearson, ML, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20:250278.Google Scholar
18.NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31:481498.CrossRefGoogle Scholar