Impact of an Antimicrobial Stewardship Program on Antimicrobial Utilization, Bacterial Susceptibilities, and Financial Expenditures at an Academic Medical Center

Abstract

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.

Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study

“…AMS efforts have shown to reduce the utilization rates of antibiotics and the expenditures associated with these medicines. Studies have also shown significant reduction in the levels of resistance toward antibiotics included as targets of the programme, though this trend was not consistently recorded everywhere (5). However, even in centers with established AMS initiatives, the physician prescribing behavior is not optimal.…”

“…AMS is a set of coherent activities that results in responsible use of antibiotics, with the definition of responsible use being context-specific and updated periodically (3). The role of AMS in a healthcare facility has been demonstrated through various studies (4)(5)(6). These studies show significant reduction in use of antimicrobials, expenditure associated with antimicrobial use and levels of resistance among various indicator pathogens.…”

Antimicrobial usage at a large teaching hospital in Lusaka, Zambia

“…[3,4] AMS programs also tend to result in medication cost-savings, since appropriate antimicrobial can lead toward overall decreased use, independent of the resource setting. [5][6][7][8][9][10][11] While antimicrobial resistance is a global problem, AMS efforts vary widely by continent and country, and data on AMS in resource-limited settings are scarce. The 2015 international cross-sectional survey of 660 hospital AMS programs in 67 countries revealed vast differences in maturity of AMS programs by country.…”

Right-Sizing Technology in the Era of Consumer-Driven Health Care

“…Yet still, at the end of the day, the laboratory is expected to produce quality results for improved patient care. Initiatives like antibiotic stewardship are helping to drive better outcomes with laboratory results, but many of these programs are dependent on post-analytical variables for the optimal impact on patient care to be realized [1,2].…”