Blog | Thursday, October 20, 2011

QD: News Every Day--Antimicrobial stewardship having some impact at hospitals

Hospital antimicrobial stewardship programs are prompting more appropriate prescribing of antibiotics, leading to improved patient care, less microbial resistance and lower costs, three studies show.

A survey of 270 U.S. hospitals found all have implemented programs, but fewer than one in three fully comply with the 2007 Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) antimicrobial stewardship guidelines, according to several studies being presented at the 49th Annual Meeting of IDSA.

Research studies presented at the meeting found a decrease in resistance, as well as a decrease in cost with implementation of these programs, the organization announced in a press release.

Susceptibility to antibiotics improved substantially under the antimicrobial stewardship program established in 1993 at Wesley Medical Center, Wichita, Kan., suggesting the program has helped in combating antibiotic resistance. The 17-year study also determined that the money spent on antibiotics decreased during that time period.

Susceptibility of gram-negative bacteria to standard antibiotic therapy increased at the time the stewardship program began, suggesting but not proving causality. In 2003, 66% of Pseudomonas aeruginosa cultures were susceptible to gentamicin and 68% to ceftazidime, but their susceptibility increased by 2009 to 92 and 90%, respectively. Susceptibility to ampicillin-sulfate by Escherichia coli increased from 63% in 1995 to 83% in 2007 and by Klebsiella pneumoniae from 75% in 1994 to 97% in 2007.

And, while antibiotics comprised 22% of Wesley's pharmacy budget at the start of the program, the drugs now make up 9 to 14% of the budget.

A University of Minnesota study also reported on cost savings. Administrators saved a total of $732,758 within two years of establishing an antibiotic stewardship program at two hospitals in 2007. Net savings to the hospital was $243,758 after factoring in salary costs for the infectious diseases physicians and pharmacists working on the program. The hospitals saved money by reducing inappropriate antibiotic use, as well as using less-expensive antibiotics when they were warranted.

The average number of antibiotics prescribed per adult patient declined from 2.39 to 2.34 (2.1%) and per pediatric patient from 2.98 to 2.37 (20.5%). Antibiotic doses per patient/day declined by 7% and antibiotic costs per patient/day declined by $7.40. The quality of care was not adversely affected, authors noted.

But, less than a third of hospitals fully comply with IDSA/SHEA Antimicrobial Stewardship guidelines, according to a University of Houston-Cardinal Health survey.

Of the 270 U.S. hospitals who completed the survey, all had implemented some components of stewardship, but 184 (68.1%) were not fully compliant. The most common reason for partial compliance, cited by 121 hospitals (44.8%), was lack of funding and personnel.