1064. Antimicrobial Stewardship Program at a Large Academic Medical Center, Impact Over 12 Years

Abstract Background The University of Minnesota Medical Center (UMMC) is a tertiary care facility, which has had a comprehensive antimicrobial stewardship program (ASP) for 12 years. Methods The antimicrobial stewardship team is comprised of a full-time PharmD and ID staff physicians. Recommendations are placed in the electronic medical record as a progress note. Verbal recommendations may also be made. Results There was a downward trend in Hospital-acquired (HA) C. difficile diarrhea from 2007 to 2014 from 1.2 to 0.5/1000 patient-days (pt day). Rates appear stable from 2014 to 2019 with adjustment for change to NHSN lab-based CDI surveillance (Figure 1). From 2009 to 2019 a decrease was seen in VRE hospital-acquired infections (HAI) from 0.53 to 0.21/1,000 patient-days and in MRSA HAIs from 0.2 to 0.14/1,000 patient-days. Newly acquired ESBL HAIs have remained relatively stable from 2009 to 2019 at 0.09 to 0.05/1,000 patient-days. CRE HAIs are low but stable rates at 0.02/1,000 patient-days (Figure 2). We track antimicrobial utilization for internal and national reporting (starting in July 2017). A SAAR for all Antibacterial agents (ICUs, wards, and oncology units) of 1.33 in 2018. Our top four agents average DOT; piperacillin/tazobactam (66.81), cefepime (34.40), oral levofloxacin (23.56) and intravenous meropenem (21.49). We demonstrate lower average DOT for our restricted antimicrobials (206.21) as compared with our nonrestricted antimicrobials (236.74) (Figure 3). Cost savings continued from year to year. After adjusting for inflation annually, our expected costs ($84.08) compared with actual costs ($40.12 ytd 2019), demonstrates effective cost management of antimicrobial agents. (Figure 4) Conclusion We observed a decrease in HAIs VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. This downward trend has continued. ESBL HAIs remain relatively stable and CRE are stable at low rates but remain emerging HAIs of concern. We are now focusing efforts on limiting unneeded fluoroquinolone and carbapenem use. We continue to analyze our SAAR data and internal DOT data to identify areas of opportunity to improve antimicrobial use. The ASP outcomes have continued to cost justify ongoing efforts. The effects of the program and the Infection Prevention Department appear to be synergistic. Disclosures All authors: No reported disclosures.

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Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

Infection Control and Hospital Epidemiology ◽

10.1086/664909 ◽

2012 ◽

Vol 33 (4) ◽

pp. 338-345 ◽

Cited By ~ 140

Author(s):

Harold C. Standiford ◽

Shannon Chan ◽

Megan Tripoli ◽

Elizabeth Weekes ◽

Graeme N. Forrest

Keyword(s):

Infectious Diseases ◽

Cost Analysis ◽

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Fiscal Year ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Large Tertiary Care

Background.An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.Design.A descriptive cost analysis before, during, and after the program.Patients/Setting.A large tertiary care teaching medical center.Methods.Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.Results.The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.Conclusions.The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

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Successful Implementation of an Antimicrobial Stewardship Program at an Academic Medical Center

Hospital Pharmacy ◽

10.1177/0018578717721535 ◽

2017 ◽

Vol 52 (7) ◽

pp. 508-513 ◽

Cited By ~ 2

Author(s):

Carolyn M. Bondarenka ◽

John A. Bosso

Keyword(s):

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Successful Implementation ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Academic Medical

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Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE

Pharmacy ◽

10.3390/pharmacy7040156 ◽

2019 ◽

Vol 7 (4) ◽

pp. 156

Author(s):

Jennifer Anthone ◽

Dayla Boldt ◽

Bryan Alexander ◽

Cassara Carroll ◽

Sumaya Ased ◽

...

Keyword(s):

Infectious Diseases ◽

Health System ◽

Antimicrobial Stewardship ◽

Program Effectiveness ◽

Medical Center ◽

Academic Medical Center ◽

Full Time ◽

Critical Access Hospitals ◽

Full Time Equivalent ◽

Stewardship Program

The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial stewardship (AMS) program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.

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Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

Journal of Contemporary Pharmacy Practice ◽

10.37901/jcphp17-00030 ◽

2019 ◽

Vol 66 (1) ◽

pp. 29-33

Author(s):

Priyam Mithawala ◽

Edo-abasi McGee

Keyword(s):

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Intervention Group ◽

Antibiotic Use ◽

Control Group ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Significant Difference ◽

The Impact

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

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Evaluation of Antimicrobial Therapy Orders Circumventing an Antimicrobial Stewardship Program: Investigating the Strategy of “Stealth Dosing”

Infection Control and Hospital Epidemiology ◽

10.1086/513535 ◽

2007 ◽

Vol 28 (05) ◽

pp. 551-556 ◽

Cited By ~ 34

Author(s):

Lori Ann LaRosa ◽

Neil O. Fishman ◽

Ebbing Lautenbach ◽

Ross J. Koppel ◽

Knashawn H. Morales ◽

...

Keyword(s):

Study Design ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Cross Sectional ◽

Stewardship Program ◽

Prior Approval

Objective. Prior-approval antimicrobial stewardship programs (ASPs) improve patient outcomes and decrease antimicrobial resistance. These benefits would be limited if physicians circumvented ASP efforts. We evaluated whether prescribers wait until after the prior-approval period to order restricted antimicrobial therapy that is in conflict with guidelines or unnecessary. Design. A cross-sectional study design and a retrospective cohort study design. Setting. A tertiary care, academic medical center with a prior-approval ASP that was active between 8 AM and 10 PM. Methods. We evaluated whether there was an increase in the proportion of orders for antimicrobial therapy that involve restricted (vs nonrestricted) antimicrobials during the first hour that the ASP is inactive (ie, the first hour that prior approval is not required), compared with the remainder of the day. We also evaluated whether restricted antimicrobial therapy ordered during this first hour is less likely to be continued when the ASP becomes active the next day, compared with that ordered during the preceding hour. Results. A greater proportion of the antimicrobial therapy orders placed between 10:00 PM and 10:59 PM were for restricted agents, compared with orders placed during other periods (57.0% vs 49.9%; P = .02). Surgical patients for whom antimicrobial therapy orders were placed between 10:00 PM and 10:59 PM were less likely to have that antimicrobial therapy continued, compared with patients whose therapy was ordered between 9:00 PM and 9:59 PM (60.0% vs 98.1%; P <.001). Nonsurgical patients whose therapy orders were placed between 10:00PM and 10:59 PM were also less likely to have the ordered antimicrobial therapy continued, compared with patients whose therapy was ordered between 9:00 PM and 9:59 PM (70.8% vs 84.2%; P = .01). Conclusion. Physicians avoid having to obtain prior approval for therapy involving restricted antimicrobials by waiting until restrictions are no longer active to place orders. Compared with restricted antimicrobial therapy ordered when the ASP is active, these courses of therapy are less often continued by the ASP, suggesting that they are more likely to be in conflict with guidelines or unnecessary.

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