Abstract
BackgroundAntimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback.MethodsFor one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology) and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents.ResultsThe antimicrobial stewardship team (AST) made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 – December 2010). Physicians implemented recommendation(s) from each of 234 (75%) audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 – August 2009), there was a 22% decrease in defined daily doses per 100 admissions (P = .006) and a 16% reduction per 1000 patient-days (P = .013). There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013) and a 25% acquisition cost reduction per patient-day (P = .022).ConclusionsAn effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.
Highlights
Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile
Hospitals with less than 200 beds accounted for 72% of American Hospital Association-defined community hospitals in 2008 and 63% of the acute care facilities reporting to the National Healthcare Safety Network (NHSN) in 2010 [1,2]
We report the implementation of a contemporary antimicrobial stewardship programs (ASPs) on the medical-surgical service of a 100-bed community hospital
Summary
Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. A 2011 report of a survey of infectious diseases (ID) specialists of the IDSA Emerging Infections Network concludes that “small community hospitals still represent the ‘frontier’ for new stewardship programs” and that they are the hospitals “least likely to have ASPs, the least likely to provide compensation to physicians, and the least likely to believe that any outcomes data might convince administrators to support ASPs” [12]. Smaller hospitals may have higher rates of antimicrobial use than those of large academic medical centers [13] It has been nearly a decade since the only report of an ASP from a community hospital in the United States with less than 200 beds [14]. We report the implementation of a contemporary ASP on the medical-surgical service of a 100-bed community hospital
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