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Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention

Published online by Cambridge University Press:  05 December 2016

Jennifer Dela-Pena ,
Luiza Kerstenetzky ,
Lucas Schulz ,
Ron Kendall ,
Alexander Lepak  and
Barry Fox
Jennifer Dela-Pena
Affiliation:
Department of Pharmacy, UW Health, Madison, Wisconsin
Luiza Kerstenetzky
Affiliation:
Department of Pharmacy, UW Health, Madison, Wisconsin
Lucas Schulz*
Affiliation:
Department of Pharmacy, UW Health, Madison, Wisconsin
Ron Kendall
Affiliation:
Department of Pharmacy, UW Health, Madison, Wisconsin
Alexander Lepak
Affiliation:
Division of Infectious Diseases, Department of Medicine, UW Health, Madison, Wisconsin
Barry Fox
Affiliation:
Division of Infectious Diseases, Department of Medicine, UW Health, Madison, Wisconsin
*
Address correspondence to Lucas Schulz, PharmD, Department of Pharmacy, UW Health, 600 Highland Ave, Madison, WI 53792 (lschulz2@uwhealth.org).
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Abstract

OBJECTIVE

To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization.

DESIGN

Retrospective cohort study.

PATIENTS

Top 1% of the antimicrobial budget from July 1 through December 31, 2014.

METHODS

Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents.

RESULTS

A total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care.

CONCLUSION

Antimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials.

Infect Control Hosp Epidemiol 2017;38:259–265

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 259 - 265
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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