Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital

Nguyen, Storey, Pate, Chang, Chang Fung

Description

Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile . Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback. Methods For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents. Results The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 – December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 – August 2009), there was a 22% decrease in defined daily doses per 100 admissions ( P = .006) and a 16% reduction per 1000 patient-days ( P = .013). There was a 32% reduction in antimicrobial acquisition cost per admission ( P = .013) and a 25% acquisition cost reduction per patient-day ( P = .022). Conclusions An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.

Sujets

• ASP

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 14
• Langue: English

Extrait

Storeyet al. Antimicrobial Resistance and Infection Control2012,1:32 http://www.aricjournal.com/content/1/1/32

R E S E A R C H

Open Access

Implementation of an antimicrobial stewardship program on the medicalsurgical service of a 100bed community hospital 1*†1†2 3 Donald F Storey , Perry G Pate , Autumn TT Nguyen and Fung Chang

Abstract Background:Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance andClostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medicalsurgical service of a 100bed community hospital employing a core strategy of postprescriptive audit with intervention and feedback. Methods:For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made nonbinding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patientday were calculated monthly for all administered antimicrobial agents. Results:The antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16month intervention period (September 2009–December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8month baseline period (January 2009–August 2009), there was a 22% decrease in defined daily doses per 100 admissions (P= .006) and a 16% reduction per 1000 patientdays (P= .013). There was a 32% reduction in antimicrobial acquisition cost per admission (P= .013) and a 25% acquisition cost reduction per patientday (P= .022). Conclusions:An effective antimicrobial stewardship program was implemented with limited resources on the medicalsurgical service of a 100bed community hospital. Keywords:Antimicrobial stewardship, ASP, Small community hospital

Background Hospitals with less than 200 beds accounted for 72% of American Hospital Associationdefined community hos pitals in 2008 and 63% of the acute care facilities report ing to the National Healthcare Safety Network (NHSN) in 2010 [1,2]. Recent reports have demonstrated that large and small hospitals alike comparably share the problem of antimicrobial resistance. An analysis of data

* Correspondence: [e-mail] † Equal contributors 1 Dallas ID Associates, Dallas, Texas, USA Full list of author information is available at the end of the article

from the National Nosocomial Infection Surveillance (NNIS) System demonstrated parallel increases in anti microbial resistance inStaphylococcus aureusblood stream infections,Escherichia coliurinary tract infec tions andPseudomonas aeruginosapneumonias within large and small acutecare facilities between the periods of 1990–1994 and 2000–2004 [3]. In addition, intensive care units of small and large hospitals reporting to NHSN were shown to have comparable proportions of deviceassociated infections with multidrugresistant Klebsiella pneumoniaeandE. coli[4]. Similarly, the pro portion ofAcinetobacter baumanniithat was multidrug

© 2012 Storey et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.