Hostname: page-component-f554764f5-8cg97 Total loading time: 0 Render date: 2025-04-13T22:23:59.545Z Has data issue: false hasContentIssue false
  • English
  • Français

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

Published online by Cambridge University Press:  02 January 2015

Harold C. Standiford ,
Shannon Chan ,
Megan Tripoli ,
Elizabeth Weekes  and
Graeme N. Forrest
Harold C. Standiford*
Affiliation:
University of Maryland Medical Center, Baltimore, Maryland Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Shannon Chan
Affiliation:
Department of Pediatrics, A. I. DuPont Hospital for Children, Wilmington, Delaware
Megan Tripoli
Affiliation:
University of Maryland Medical Center, Baltimore, Maryland
Elizabeth Weekes
Affiliation:
Department of Pharmacy, Denver Health, Denver, Colorado
Graeme N. Forrest
Affiliation:
Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon
*
University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Baltimore, MD 21201 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.

Design.

A descriptive cost analysis before, during, and after the program.

Patients/Setting.

A large tertiary care teaching medical center.

Methods.

Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.

Results.

The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.

Conclusions.

The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 4: Special Topic Issue: Antimicrobial Stewardship , April 2012 , pp. 338 - 345
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1–12.CrossRefGoogle ScholarPubMed
2. Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.Google Scholar
3. Carling, PC, Fung, T, Coldiron, JS. Parenteral antibiotic use in acute-care hospitals: a standardized analysis of fourteen institutions. Clin Infect Dis 1999;29:1189–1196.CrossRefGoogle ScholarPubMed
4. McGregor, JC, Weekes, E, Forrest, GN, et al. Impact of a computerized decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc 2006;13:378–384.Google Scholar
5. Carling, P, Fung, T, Killion, A, et al. Favorable impact of a mul-tidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24:699–706.Google Scholar
6. Stevens, V, Dumyati, G, Fine, S, et al. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:42–48.CrossRefGoogle ScholarPubMed
7. Fishman, N. Antimicrobial stewardship. Am J Med 2006;119: S53–S61.Google Scholar
8. Singh, N, Rogers, P, Atwood, CW, et al. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. Am JRespir Crit Care Med 2000;162:505–511.Google Scholar
9. Hoffman, JM, Shan, ND, Vermeulen, LC, Schumock, GT, Grim, P, Hunkler, RJ, Hontz, KM. Projecting future drug expenditures: 2007. Am J Health Syst Pharm 2007;64:298–314.CrossRefGoogle ScholarPubMed
10. Rybak, M, Lomaestro, B, Rotschafer, JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009;66:82–98.Google Scholar