Antimicrobial Stewardship in a Community Hospital: An effective cost reducing strategy
Aman Dalal, M.D.1; Deborah Figueroa, Pharm.D.2; Webheh Webheh, M.D. 1,3; Carl Urban, Ph.D. 1,4; James Rahal, M.D. 1,3
Division of Infectious Diseases, New York Hospital Queens1
Pharmacy Department, New York Hospital Queens2
Department of Medicine, Weill Cornell Medical College3
Department of Microbiology, Weill Cornell Medical College4
Purpose: The goals of a successful antimicrobial stewardship program targets cost and prevention of antimicrobial resistance. Prolonged antimicrobial use, suboptimal dosing and inappropriate empirical selection are key issues that need monitoring. A partnership among Infectious Diseases, Pharmacy and Microbiology Departments endeavors to reduce cost, prevent resistance and promote safety through education and targeted interventions.
Methods: All patients receiving antimicrobials on a specific floor were evaluated using clinical and laboratory findings on seven separate days form November 2008 to March 2009. The appropriateness of antibiotic therapy was determined and discussed with the treating Physician and recommendations were made. Patients who had been seen by an Infectious Disease Consultant were excluded. The cost savings were determined for a three-day period (minimum savings) or for the number of days between intervention (defined as discontinuation, de-escalation, renal adjustment and intravenous to enteral) and withdrawal of antibiotics or hospital discharge (actual savings).
Results: During the five-month study period, 81 patients were reviewed; Antibiotic adjustments were recommended for 70 patients and of these 53 recommendations were accepted.
Conclusions: Antimicrobial stewardship reduced antibiotic drug expenditures with a minimum to maximum cost savings of $ 2890 to $ 6190. Our review yielded intervention in 86% of the patients evaluated and these interventions were accepted and implemented in 76% of the patients.. We extrapolated that annually we can save a minimum to a maximum of $95,411 to $ 229, 910.