Infection Control & Hospital Epidemiology

Original Article

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

Harold C. Standiforda1a2 c1, Shannon Chana3, Megan Tripolia1, Elizabeth Weekesa4 and Graeme N. Forresta5

a1 University of Maryland Medical Center, Baltimore, Maryland

a2 Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland

a3 Department of Pediatrics, A. I. DuPont Hospital for Children, Wilmington, Delaware

a4 Department of Pharmacy, Denver Health, Denver, Colorado

a5 Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon


Background. An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.

Design. A descriptive cost analysis before, during, and after the program.

Patients/Setting. A large tertiary care teaching medical center.

Methods. Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.

Results. The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.

Conclusions. The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

(Received October 01 2011)

(Accepted December 27 2011)


c1 University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Baltimore, MD 21201 (