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Impact of an Antimicrobial Utilization Program on Antimicrobial Use at a Large Teaching Hospital A Randomized Controlled Trial

Published online by Cambridge University Press:  02 January 2015

Bernard C. Camins ,
Mark D. King ,
Jane B. Wells ,
Heidi L. Googe ,
Manish Patel ,
Ekaterina V. Kourbatova  and
Henry M. Blumberg
Bernard C. Camins
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia
Mark D. King
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia
Jane B. Wells
Affiliation:
Pharmacy and Drug Information, Grady Memorial Hospital, Atlanta, Georgia
Heidi L. Googe
Affiliation:
Pharmacy and Drug Information, Grady Memorial Hospital, Atlanta, Georgia
Manish Patel
Affiliation:
Pharmacy and Drug Information, Grady Memorial Hospital, Atlanta, Georgia
Ekaterina V. Kourbatova
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia Departments of Epidemiology, Grady Memorial Hospital, Atlanta, Georgia
Henry M. Blumberg*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia Departments of Epidemiology, Grady Memorial Hospital, Atlanta, Georgia
*
Emory University School of Medicine, Div of Infectious Diseases, 49 Jesse Hill Dr, Atlanta, GA 30303 (henry.m.blumberg@emory.edu)
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Abstract

Background.

Multidisciplinary antimicrobial utilization teams (AUTs) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited.

Objective.

To determine the impact of an AUT on antimicrobial use at a teaching hospital.

Design.

Randomized controlled intervention trial.

Setting.

A 953-bed, public, university-affiliated, urban teaching hospital.

Patients.

Patients who were given selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams.

Intervention.

Twelve internal medicine teams were randomly assigned monthly: 6 teams to an intervention group (academic detailing by the AUT) and 6 teams to a control group that was given indication-based guidelines for prescription of broad-spectrum antimicrobials (standard of care), during a 10-month study period.

Measurements.

Proportion of appropriate empirical, definitive (therapeutic), and end (overall) antimicrobial usage.

Results.

A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of antimicrobial prescriptions written by the intervention teams that was considered to be appropriate was significantly higher than the proportion of antimicrobial prescriptions written by the control teams that was considered to be appropriate: 82% versus 73% for empirical (risk ratio [RR], 1.14; 95% confidence interval [CI], 1.04-1.24), 82% versus 43% for definitive (RR, 1.89; 95% CI, 1.53-2.33), and 94% versus 70% for end antimicrobial usage (RR, 1.34; 95% CI, 1.25-1.43). In multivariate analysis, teams that received feedback from the AUT alone (adjusted RR, 1.37; 95% CI, 1.27-1.48) or from both the AUT and the infectious diseases consultation service (adjusted RR, 2.28; 95% CI, 1.64-3.19) were significantiy more likely to prescribe end antimicrobial usage appropriately, compared with control teams.

Conclusions.

A multidisciplinary AUT that provides feedback to prescribing physicians was an effective method in improving antimicrobial use.

Trial Registration.

ClinicalTrials.gov identifier: NCT00552838.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 931 - 938
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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