Systemwide Hospital Stewardship Reduces Misuse, Cost of Antibiotics

Antibiotic cost and inappropriate use can be reduced by use of systemwide stewardship programs in hospitals, according to a study presented at ID Week 2016 in New Orleans, Louisiana.

Roy Guharoy, PharmD, MBA, vice president and Clinical Integration Chief Pharmacy Officer at Ascension Health in St. Louis, Missouri, and colleagues implemented a systemwide antibiotic stewardship program in which each hospital had a team led by a pharmacist and a physician tasked with monitoring adherence “with evidence-based antimicrobial use, culture orders, and standardized disease management processes.” The researchers examined the use of aztreonam, ceftaroline, daptomycin, linezolid, tigecycline and ertapenem at Ascension facilities.

A goal of the study was to combat the misuse of antibiotics, which researchers said occurs when antibiotics are used to treat syndromes without a bacterial origin, or when antibiotics are used longer than recommended for the targeted infection.

Monthly data reflecting the defined daily dose (DDD)/1000 patient days were shared with each facility and used to examine success rates, discover opportunities for improvement, and create action plans in the use of antibiotics. The researchers also called and visited opportunity hospitals.

Dr Guharoy and colleagues reported an 8.4% decrease in targeted use of all studied antimicrobial agents from 941.8 DDD/1000 patient days in FY2015 to 862.3 DDD/1000 in FY2016 (P <.001). The researchers also noted $4.9 million in avoided costs. There was also a “10% reduction, from 900 DDD/1000 patient days to 810, in use of all systemic antibiotics and $8 million savings.”

The highest cost savings of $3.4 million was seen with daptomycin.

“Our story reflects the impact of true collaboration between infectious disease physicians, other specialists, and pharmacy on reduced antibiotic use, decreased Clostridium difficile infection, and associated cost avoidance,” Dr Guharoy said in an interview with Infectious Disease Advisor.

“The key lessons learned from our experience are standardized antibiotic use across the system, evidence-based use of antibiotic agents, and prospective monitoring of antibiotic use by pharmacists resulting in discontinuation of therapy or change to a narrow spectrum agent and appropriate dosing/monitoring,” he said. Dr Guharoy noted the “use of a dashboard showing each facility’s successes and opportunities.”

Dr Guharoy stated that this initiative can be “implemented at any other health system by establishing antimicrobial stewardship teams at each hospital and establishing a physician and a pharmacist as leaders accountable for delivering stewardship at all settings.”  He stressed that it is important for healthcare workers to understand the need for “teamwork, evaluation of utilization data every month to understand opportunities, and prospective monitoring of all antibiotic use.”

“A system approach fosters accountability and encourages standardization at the hospital level,” the researchers said. “Prospective monitoring, established utilization criteria, utilization monitoring, and accountability” all contributed toward the program’s success.

Reference

Guharoy R, Fakih M, Seggerman J, et al.Universal implementation of antimicrobial stewardship program leads to reduction in antibiotic use and cost savings: pilot results from a large U.S. health system. Presented at: IDWeek 2016. New Orleans, LA; October 26-30, 2016. Poster 1021.