In patients with VREB, rapid organism and resistance detection by the BCID panel with ASP intervention significantly reduced time to initiation of effective therapy by over 24 hours. Non-significant improvements in clinical outcomes were observed. Additional studies are needed to determine the full implications of BCID technology on patient outcome.

mRDTs have demonstrated the ability to be one of the most powerful antimicrobial stewardship interventions. Pharmacists required to implement an ASP in their institution should consider mRDTs as standard of care for patients with BSIs.

Background: Antimicrobial stewardship programs (ASPs) have the potential to improve patient outcomes, decrease microbial resistance, increase patient safety, and decrease costs. However, to justify the costs involved with providing an ASP, it is necessary to assess its impact in achieving these outcomes on an ongoing basis. Objective: The purpose of this study was to characterize the overall impact of the ASP at an academic medical center. Methods: Quasi-experimental, before and after stewardship program implementation, retrospective analyses of quarterly antimicrobial utilization, bacterial susceptibilities, and antibiotic acquisition costs were utilized. Results: Mean stewardship-focused antibiotic utilization was 510.3 defined daily doses (DDD) per 1,000 patient days for the pre-ASP period and 426.4 DDD per 1,000 patient days for the ASP period (16.4% decrease; p < .001). Significant changes in Pseudomonas aeruginosa susceptibility to tobramycin (8% increase; p = .006) and piperacillin-tazobactam (8% decrease; p = .024) were noted. Changes in susceptibility of Staphylococcus aureus to methicillin (7% increase, p = .012) were also observed. ASP-focused antibiotic expenditures decreased from $4,028,068 in fiscal year (FY) 2010 to $2,135,173 in FY2013 (p = .01). Conclusions: ASP initiatives were associated with an observed reduction in stewardship-focused antibiotic utilization. Significant changes in susceptibilities of some bacteria were noted but did not seem to consistently reflect antibiotic utilization changes. Significant decreases in antimicrobial expenditures were observed. Observed outcomes are temporally related to shifts in antimicrobial selection through the initiation of stewardship program-driven antibiotic policy changes. These outcomes have been used to justify and expand our stewardship program moving forward.

The restriction and subsequent reduction of ciprofloxacin use was found to have a positive effect on the susceptibility of E. coli urinary isolates to ciprofloxacin.

We report the development of a collaborative relationship between antimicrobial stewardship and clinical microbiology that incorporates stewardship practices into daily laboratory rounds. Antimicrobial stewardship involvement on rounds was a welcomed and effective initiative with substantial rates of intervention. New opportunities to positively impact use of antimicrobials and laboratory resources were realized.