Potential Impact of Antibiotic Stewardship Programs on Overall Antibiotic Use in Adult Acute-Care Hospitals in the United States

Kabbani, Sarah; Baggs, James; Hicks, Lauri A.; Srinivasan, Arjun

doi:10.1017/ice.2017.273

Cited by 4 publications

(3 citation statements)

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“…Considering that a part of the audit was restriction on the use of carbapenems and vancomycin as other available broad spectrum AM options, we could at least be certain that restricting primary use of AMs did not impact patients' outcome with respect to mortality rates. This fact has also been supported previously 26 and can help reduce the bias on presuming that excessive AM use can improve safety and outcome.…”

Section: Discussionsupporting

confidence: 69%

“…This reduction presented as DDD/ 1000 patient days was considerable (26.3%) compared to recent ASP reports from US acute-care hospitals (15.8%). 26 An increase in linezolid consumption could be due to expansion of vancomycin resistant Enterococcus spp (VRE) that are a main issue in the resistance patterns at our institution. Relevant reports have shown very high consumption of linezolid at their institutions as well due to its great activity against MRSA.…”

Section: Discussionmentioning

confidence: 99%

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<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

Mahmoudi

Sepasian

Firouzabadi

et al. 2020

RMHP

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Background: Inappropriate use of antimicrobials (AM) is a major concern worldwide that leads to the propagation of antimicrobial resistance (AMR). In addition to its clinical implications, AMR imposes an economic burden on communities, especially developing countries with more infectious diseases and less available resources. Antimicrobial stewardship programs (ASPs) have been found to be effective in reducing AMR. This study was designed to evaluate the effect of implementing an ASP in reducing AM consumption, its economic burden, and AMR as a consecutive result. Materials and Methods: Consumption of caspofungin, amphotericin B, voriconazole, colistin, linezolid, vancomycin, and carbapenems was compared in a prospective crosssectional study between two time periods introduced as pre-and post-ASP. Drug use density presented as anatomical therapeutic chemical (ATC)/defined daily doses (DDD) and normalized per 1000 bed days, cost savings, and AMR patterns were evaluated. Results: A total of 9400 AM prescriptions were analyzed during a 2-year period. Consumption measured in DDD/1000 bed days dropped by 24.8, 25.0, 35.3, 47.0, 39.2, 10.5, and 23.2 percent for amphotericin B, caspofungin, colistin, voriconazole, meropenem, imipenem, and vancomycin, respectively. Linezolid consumption increased by 26.8% after implementing ASP. The expenditure of target AMs in the average value of USD decreased by 41.3% after the intervention compared to the time before using ASP (P-value=0.001). Implementing ASP also increased AM susceptibility of Pseudomonas aeruginosa, while the susceptibility of methicillin-resistant Staphylococcus aureus did not change significantly. Conclusion: The results of this study suggest that establishment of ASP can lead to a reduction in improper administration of AMs and their expenditure resulting in economic benefit and lowering AMR at hospitals with minimum resources. Clinical pharmacists' role was critical to the success of this ASP and was uniquely empowered at our center.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

Mahmoudi

Sepasian

Firouzabadi

et al. 2020

RMHP

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“…In addition, the development of new therapies and recommendations for generally more aggressive treatment of HAIs, like CDI, may also result in declines in attributable mortality but also add their own costs that must be considered [64, 65]. However, in the case of AS there may be additional impacts on morbidity and mortality that are yet to be fully understood as growing evidence suggests that the effect of unnecessary antibiotics on the microbiome may result in other adverse outcomes among hospitalized patients such as sepsis [66]. Such impacts, even if only partially realized, could even more dramatically sway the cost benefits in favor of aggressive stewardship interventions.…”

Section: Discussionmentioning

confidence: 99%

Assessing the social cost and benefits of a national requirement establishing antibiotic stewardship programs to prevent Clostridioides difficile infection in US hospitals

Scott

Slayton

Lessa

et al. 2019

Antimicrob Resist Infect Control

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BackgoundEconomic evaluations of interventions to prevent healthcare-associated infections in the United States rarely take the societal perspective and thus ignore the potential benefits of morbidity and mortality risk reductions. Using new Department of Health and Human Services guidelines for regulatory impact analysis, we developed a cost-benefit analyses of a national multifaceted, in-hospital Clostridioides difficile infection prevention program (including staffing an antibiotic stewardship program) that incorporated value of statistical life estimates to obtain economic values associated with morbidity and mortality risk reductions.MethodsWe used a net present value model to assess costs and benefits associated with antibiotic stewardship programs. Model inputs included treatment costs, intervention costs, healthcare-associated Clostridioides difficile infection cases, attributable deaths, and the value of statistical life which was used to estimate the economic value of morbidity and mortality risk reductions.ResultsFrom 2015 to 2020, total net benefits of the intervention to the healthcare system range from $300 million to $7.6 billion when values for morbidity and mortality risk reductions are ignored. Including these values, the net social benefits of the intervention range from $21 billion to $624 billion with the annualized net benefit of $25.5 billion under our most likely outcome scenario.ConclusionsIncorporating the economic value of morbidity and mortality risk reductions in economic evaluations of healthcare-associated infections will significantly increase the benefits resulting from prevention.

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Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011

Magill

O’Leary

Ray

et al. 2020

Clinical Infectious Diseases

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Background In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods The Centers for Disease Control and Prevention’s Emerging Infections Program sites in 10 states each recruited ≤25 general and women’s and children’s hospitals. Hospitals selected a survey date from May–September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6–50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Conclusions Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

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Potential Impact of Antibiotic Stewardship Programs on Overall Antibiotic Use in Adult Acute-Care Hospitals in the United States

Cited by 4 publications

References 4 publications

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

Assessing the social cost and benefits of a national requirement establishing antibiotic stewardship programs to prevent Clostridioides difficile infection in US hospitals

Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011

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