Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL.
Department of Pharmacy, Mayo Clinic Health System Hospital, Waycross, GA.
Am J Infect Control. 2017 Sep 1;45(9):979-982. doi: 10.1016/j.ajic.2017.03.024. Epub 2017 May 16.
New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff.
An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia. An educational grand rounds lecture series was provided before implementation of the ASP to all prescribers. After implementation, algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes based on local antibiograms were provided to prescribers to improve this selection. Rates of C difficile infections, total targeted antimicrobial costs, and drug utilization rates were calculated for 1 year pre-ASP implementation (2013) and 1 year post-ASP implementation (October 2014-December 2015).
The patient safety metric of C difficile infections decreased from 3.35 cases per 1,000 occupied bed days (OBDs) in 2013 to 1.35 cases per 1,000 OBDs in 2015. Total targeted antimicrobial costs decreased 50% from $16.93 per patient day in 2013 to $8.44 per patient day in 2015. Overall antimicrobial use decreased 10% from before the ASP initiative to 1 year after it. Annualized savings were $280,000 in 1 year, based on drug savings only.
Judicious use of antimicrobials and resources can improve a patient safety metric and decrease costs dramatically in rural institutions where the average hospital census is <100 patients per day. The savings would allow the institutions to spend better while improving the use of antimicrobials.
新的联合委员会抗菌药物管理要求于 2017 年 1 月 1 日生效，被推广为应对抗菌药物耐药性和艰难梭菌感染等新出现问题的核心策略。我们的目的是在佐治亚州的一家农村社区医院评估新的抗菌药物管理计划（ASP）的效果，该医院之前没有 ASP，并且有一名新的传染病专家在医院工作。
成立了一个 ASP 团队，在佐治亚州的一家农村医院实施了一项前瞻性的审计，对 12 种抗菌药物进行了医疗服务提供者反馈，并进行了审计。在实施 ASP 之前，向所有开处方者提供了一系列关于 ASP 的教育大查房讲座。实施后，根据当地抗生素药敏试验结果，为开处方者提供了针对特定传染病综合征的经验性抗生素选择算法，以提高这种选择的准确性。在 ASP 实施前（2013 年）和实施后（2014 年 10 月至 2015 年 12 月），计算了 1 年的艰难梭菌感染率、总目标抗菌药物成本和药物利用率。
患者安全指标艰难梭菌感染从 2013 年每千占用病床日（OBD）3.35 例降至 2015 年每千 OBD 1.35 例。2013 年每患者日 16.93 美元降至 2015 年每患者日 8.44 美元，总目标抗菌药物成本降低 50%。ASP 实施前至实施后 1 年，总体抗菌药物使用率下降 10%。仅基于药物节省，1 年内年化节省 28 万美元。
在平均每天住院人数<100 人的农村机构中，合理使用抗菌药物和资源可以改善患者安全指标，并显著降低成本。这些节省将使机构在改善抗菌药物使用的同时，更好地进行资源分配。
