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Controlling Use of Antimicrobials in a Community Teaching Hospital

Published online by Cambridge University Press:  21 June 2016

Carla Philmon ,
Terri Smith ,
Sharon Williamson  and
Edward Goodman
Carla Philmon*
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
Terri Smith
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
Sharon Williamson
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
Edward Goodman
Affiliation:
Department of Infectious Diseases, Pharmacy, and Laboratory, Presbyterian Hospital of Dallas, Dallas, Texas
*
Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231 (carlaphilmon@texashealth.org)
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Abstract

Objective.

To test the hypothesis that antibiotic use could be controlled or improved in a community teaching hospital, with improvement defined as reductions in overall use, overall cost, and antimicrobial resistance.

Design.

Interventional study with historical comparison.

Setting.

A not-for-profit, 900-bed community general hospital with residents in medicine, surgery, obstetrics-gynecology, and psychiatry.

Participants.

Physicians who requested any of the targeted antibiotics.

Interventions.

Three categories of inpatient antibiotic orders were monitored beginning in April 2001: conversion from intravenous to oral administration for selected highly bioavailable antimicrobials, cessation of perioperative prophylaxis within 24 hours for patients undergoing clean and clean-contaminated surgery, and consultation with an infectious diseases physician before continuing administration of selected drugs beyond 48 hours. Data were analyzed after the first 33 months. Patient outcomes were reviewed during the hospital stay and at readmission if it occurred within 30 days after discharge.

Results.

From April 2001 through December 2003, a total of 1426 requests for antimicrobial therapy met criteria for intervention. Overall physician compliance with the program was 76%, ranging from 57% for perioperative prophylaxis to 92% for intravenous to oral conversion. Antimicrobial costs per patient-day decreased by 31%, from $13.67 in 2000 (before program implementation) to $9.41 in 2003. Total savings in acquisition costs were $1,841,203 for the 3-year period. Resistance to numerous drugs among Klebsiella pneumoniae isolates was also significantly reduced.

Conclusions.

A program to improve the use of antibiotics in a community hospital was successful in reducing overall use, overall cost, and antimicrobial resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 3 , March 2006 , pp. 239 - 244
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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