Impact of an antimicrobial stewardship program in a medium-sized hospital

Abstract

Problem considered: The rational use of antimicrobials (ATMs) is a challenge for global health services. One strategy used to control the spread of multidrug-resistant (MDR) bacteria is antimicrobial management programs. This is a pre- and post-intervention study that assesses the impact of an antimicrobial stewardship program in a hospital through evaluating clinical and microbiological outcomes, usage measures and costs. Methods: The sample comprised adult patients hospitalized for more than 24 h during a seven-month pre-intervention, and an eleven-month post-intervention period. Primary outcomes included length of therapy (LOT) and days of therapy (DOT) per 1000 patient-days (pd), the DOT/LOT ratio, the incidence of a number of the main multi-drug resistant bacteria, and the costs of therapy. Secondary outcomes were the use of antimicrobials and antimicrobial prescriptions by class, hospital length of stay rates, and mortality rates. Data were obtained from medical prescriptions, pre-authorization forms for restricted antibiotics, and microbiological tests. Non-critical and critical care units were compared, with a significance level of 0.05. Results: A total of 2704 patients were evaluated and there was a significant post-intervention reduction of exposure to antimicrobials of 8.1% and of 90 days in respect of the LOT in non-critical units. There was a reduction of more than 50% in the costs of therapy and of 1.2 days in the length of hospital stay in non-critical units. There was no variation in bacterial resistance. Conclusions: Although the stewardship program and its interventions reduced antimicrobial consumption, costs and the length of hospital stay further studies are required to identify the components that can produce the impact on microbiological outcomes seen in other studies.

Keywords

• Antimicrobial agents
• Microbial drug resistance
• Multiple bacterial pharmacoresistance
• Hospital costs
• Public hospitals