Rigorous antibiotic stewardship in the hospitalized elderly population: saving lives and decreasing cost of inpatient care.

James Mauro,David Livert,Roman A Tuma,Saman Kannangara,Joanne Peterson

doi:10.1093/jacamr/dlab118

Abstract

BackgroundThere is limited literature evaluating the effect of antibiotic stewardship programmes (ASPs) in hospitalized geriatric patients, who are at higher risk for readmissions, developing Clostridioides difficile infection (CDI) or other adverse outcomes secondary to antibiotic treatments.MethodsIn this cohort study we compare the rates of 30 day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. We also assessed their mortality rates and length of stay. Patients were included if they received antibiotics for pneumonia, urinary tract infection, acute bacterial skin and skin structure infection or complicated intra-abdominal infection. The ASP team reviewed patients on antibiotics daily. ASP interventions included de-escalation of empirical or definitive therapy, change in duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission because of reinfection or a new infection. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analysed for comparison.ResultsWe demonstrated that the 30 day hospital readmission rate for all infection types decreased during the ASP intervention period from 24.9% to 9.3%, P < 0.001. The rate of 30 day readmissions because of CDI decreased during the intervention period from 2.4% to 0.30%, P = 0.02. Mortality in the cohort that underwent ASP interventions decreased from 9.6% to 5.4%, P = 0.03. Lastly, antibiotic expenditure decreased after implementation of the ASP from $23.3 to $4.3 per adjusted patient day, in just 6 months.ConclusionsRigorous de-escalation and curtailing of antibiotic therapies were beneficial and without risk for the hospitalized patients 65 years and over.

Highlights

More than 50% of patients in the USA receive one or more antibiotic treatments during their hospital stay, and MDR bacteria are ever increasing.[1]
The majority of antibiotic stewardship programmes (ASPs) interventions were de-escalations (62%) and discontinuations (24%) (Table 2). These interventions resulted in a remarkable decrease of broadspectrum antibiotic therapies as well as glycopeptide utilization (Table 1)
First-generation cephalosporin and penicillin as well as aminopenicillin antibiotics were not administered in the intervention group prior to ASP recommendation nor in the historical control group (Table 1)

Summary

Introduction

More than 50% of patients in the USA receive one or more antibiotic treatments during their hospital stay, and MDR bacteria are ever increasing.[1] The 2019 Antibiotic Threats Report by the CDC stated that more than 2.8 million antibiotic resistant infections occur in the USA each year, and more than 35 000 people died as a result. In 2017, nearly 223 900 people required hospitalization in the USA because of Clostridioides difficile infections (CDIs), and at least 12 800 people died thereof. There is limited literature evaluating the effect of antibiotic stewardship programmes (ASPs) in hospitalized geriatric patients, who are at higher risk for readmissions, developing Clostridioides difficile infection (CDI) or other adverse outcomes secondary to antibiotic treatments

Methods

Results

Conclusion