Infection Control & Hospital Epidemiology

Original Article

Evaluation of Postprescription Review and Feedback as a Method of Promoting Rational Antimicrobial Use: A Multicenter Intervention

Sara E. Cosgrovea1 c1, Susan K. Seoa2, Maureen K. Bolona3, Kent A. Sepkowitza2, Michael W. Climoa4, Daniel J. Diekemaa5, Kathleen Specka6, Vidhya Gunaseelana7, Gary A. Noskina3, Loreen A. Herwaldta5, Edward Wonga4, Trish M. Perla1 and CDC Prevention Epicenter Program

a1 Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

a2 Memorial Sloan Kettering Cancer Center, New York, New York

a3 Feinberg School of Medicine, Northwestern University, Chicago, Illinois

a4 Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia

a5 University of Iowa Carver College of Medicine, Iowa City, Iowa

a6 Quality and Safety Research Group, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

a7 Antimicrobial Stewardship Program, Johns Hopkins Hospital, Baltimore, Maryland

Abstract

Objective. To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use.

Design. Quasi-experimental before-after study.

Setting. Five academic medical centers.

Patients. Adults receiving at least 48 hours of study-ABX.

Methods. The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study-ABX per 1,000 study-patient-days in the baseline and intervention periods.

Results. There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97; P = .002) at hospital В and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P < .001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses.

Conclusions. Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.

(Received October 11 2011)

(Accepted December 22 2011)

Correspondence

c1 Osler 425, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287 (scosgrol@jhmi.edu)