Impact of an antimicrobial stewardship program on patients with acute bacterial skin and skin structure infections

Abstract

The impact of an antimicrobial stewardship program (ASP) on the management of therapy and hospital resources for patients with acute bacterial skin and skin structure infections (ABSSSIs) at a community teaching hospital was evaluated. A retrospective, observational chart review was performed to evaluate the impact of the ASP on patients admitted to Akron City Hospital with a diagnosis of ABSSSI between February 1 and August 20, 2012. Information on patient demographic characteristics, comorbidities, ABSSSI subtype, antibiotic therapy, microbiology, surgical interventions, and ASP recommendations was collected from medical records and the ASP intervention log. ASP recommendations were organized into five categories: dosage changes, de-escalation, antibiotic regimen change (i.e., change antibiotic regimen to a broad-spectrum antimicrobial or target a pathogen not being covered), infectious diseases (ID) formal consultation, and other. A total of 62 patients were included in the study. A total of 85 recommendations were made to attending physicians for these 62 patients, with an acceptance rate of 95%. The most common interventions included dosage changes, de-escalation, antibiotic regimen change, and ID consultation. When compared with historical data for 1149 patients, the intervention group had a significantly lower mean length of stay (LOS). The 30-day all-cause readmission rate was also significantly lower in the intervention group; however, the 30-day ABSSSI readmission rate did not differ significantly between groups. Interventions made by an ASP including a clinical pharmacist were associated with significant reductions in the mean LOS and 30-day all-cause readmission rate for patients with an ABSSSI compared with historical data.