Structure of Antimicrobial Stewardship Programs in Leading U.S. Hospitals

Abstract

BackgroundAntibiotic use has drastically changed the course of modern medicine. However, the overuse and often inappropriate use of antibiotics has led to the development of resistant strains of bacteria. Increasingly, healthcare systems struggle to deal with the burden of fighting infections that no longer respond to common antibiotic-based treatments. One strategy used to combat antibiotic resistance is the implementation of hospital-based Antimicrobial Stewardship Programs (ASP). ASP structure among the top U.S hospitals may provide insight into which of the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) ASP recommendations are most efficacious given limited resources. We thus administered a survey to better understand the elements of an ASP that are utilized at these top-rated hospitals.MethodsWe surveyed the 50 highest ranking hospitals in various specialties using the 2015-2016 U.S News lists of top hospitals. This corresponded to 137 adult and 70 pediatric sites. We inquired as to which components of the 2016 IDSA and SHEA ASP guidelines were implemented at each site. Appropriate persons at each hospital were contacted by telephone and email.ResultsOverall, 102 of 207 hospitals responded (49.3%). Of these 87.2% had an active ASP, and 57.1% were active for more than 5 years. Interventions most widely adopted included prospective auditing of antimicrobial usage (n = 65, 87.8%), pre-authorization of antimicrobials (n = 61, 82.4%), and antimicrobials restricted to infectious disease physicians (n = 52, 70.3%). The most widely implemented optimization strategies included promoting transition from intravenous to oral antibiotics (n = 68, 93.2%) and strategies to minimize antimicrobial therapy duration (n = 56, 76.7%). The least common interventions included antimicrobial time-outs (n = 17, 23.0%) and ASP intervention in cases with high risk of Clostridium Difficile infection (n = 27, 36.5%). The least common optimization strategy was the use of time-sensitive stop orders 
(n = 27, 37.0%).ConclusionMost leading U.S hospitals selectively implement IDSA and SHEA recommendations. Understanding the structure of ASPs in these hospitals will assist other hospitals in implementing their programs.Disclosures All authors: No reported disclosures.