Department of Internal Medicine, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
Am J Infect Control. 2013 Feb;41(2):145-8. doi: 10.1016/j.ajic.2012.02.021. Epub 2012 May 10.
Data from community antimicrobial stewardship programs (ASPs) are limited. We describe clinical and economic outcomes from the first year of our hospital's ASP.
The ASP team comprised 2 infectious disease physicians and 3 intensive care unit pharmacists. The team prospectively audited the new starts and weekly use of 8 target antimicrobials: aztreonam, caspofungin, daptomycin, ertapenem, linezolid, meropenem, tigecycline, and voriconazole. Using administrative data, outcomes from the first year of the program, including death within 30 days of hospitalization, readmission within 30 days of discharge, and development of Clostridium difficile infection (CDI), were compared with outcomes from a similar period before institution of the program.
A total of 510 antimicrobial orders were reviewed, of which 323 (63%) were appropriate, 94 (18%) prompted deescalation, 61 (12%) were denied, and 27 (5%) led to formal consultation with an infectious disease physician. On multivariate analysis, implementation of the ASP was associated with an approximate 50% reduction in the odds of developing CDI (odds ratio, 0.46; 95% confidence interval, 0.25-0.82). The ASP was not associated with decreased mortality at 30 days after discharge or readmission rate. The antimicrobial cost per patient-day decreased by 13.3%, from $10.16 to $8.81. The antimicrobial budget decreased by 15.2%, resulting in a total savings of $228,911. There was a 25.4% decrease in defined daily doses of the target antimicrobials.
Implementation of the ASP was associated with significant reductions in CDI rate, antimicrobial use, and pharmacy costs.
社区抗菌药物管理项目（ASPs）的数据有限。我们描述了我院 ASP 实施第一年的临床和经济结果。
ASP 团队由 2 名传染病医生和 3 名重症监护病房药剂师组成。该团队前瞻性地审核了 8 种目标抗生素的新启动和每周使用情况：氨曲南、卡泊芬净、达托霉素、厄他培南、利奈唑胺、美罗培南、替加环素和伏立康唑。使用行政数据，比较了该计划实施前的类似时期内，住院后 30 天内死亡、出院后 30 天内再入院以及艰难梭菌感染（CDI）发展的结果。
共审查了 510 份抗菌药物医嘱，其中 323 份（63%）是适当的，94 份（18%）提示降级，61 份（12%）被拒绝，27 份（5%）导致与传染病医生进行正式咨询。多变量分析显示，实施 ASP 与 CDI 发生的几率降低约 50%相关（比值比，0.46；95%置信区间，0.25-0.82）。ASP 与出院后 30 天内死亡率或再入院率降低无关。每位患者每天的抗菌药物费用减少了 13.3%，从 10.16 美元降至 8.81 美元。抗菌药物预算减少了 15.2%，总计节省 228911 美元。目标抗菌药物的限定日剂量减少了 25.4%。
实施 ASP 与 CDI 发生率、抗菌药物使用和药房成本的显著降低相关。
