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Favorable Impact of a Multidisciplinary Antibiotic Management Program Conducted During 7 Years

Published online by Cambridge University Press:  02 January 2015

Philip Carling ,
Teresa Fung ,
Ann Killion ,
Norma Terrin  and
Michael Barza
Philip Carling*
Affiliation:
Infectious Diseases Section, Carney Hospital, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts Tufts University School of Medicine, Boston, Massachusetts
Teresa Fung
Affiliation:
Infectious Diseases Section, Carney Hospital, Boston, Massachusetts
Ann Killion
Affiliation:
Infectious Diseases Section, Carney Hospital, Boston, Massachusetts
Norma Terrin
Affiliation:
Tufts University School of Medicine, Boston, Massachusetts
Michael Barza
Affiliation:
Infectious Diseases Section, Carney Hospital, Boston, Massachusetts Tufts University School of Medicine, Boston, Massachusetts
*
Infectious Diseases Section, Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124
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Abstract

Objective:

To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years.

Design:

Prospective study with comparison with preintervention trends.

Setting:

University-affiliated teaching hospital.

Patients:

All adult inpatients.

Intervention:

A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size.

Results:

Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P= .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates.

Conclusion:

These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 9 , September 2003 , pp. 699 - 706
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Kunin, CM, Tupasi, T, Craig, WA. Use of antibiotics: a brief exposition of the problem and some tentative solutions. Ann Intern Med 1973:79:555–560.CrossRefGoogle ScholarPubMed
2.Kunin, CM. Evaluation of antibiotic usage: a comprehensive look at alternative approaches. Rev Infect Dis 1981;34:745–753.CrossRefGoogle Scholar
3.Kunin, CM. The responsibility of the infectious disease community for the optimal use of antimicrobial agents. J Infect Dis 1985;151:388–398.CrossRefGoogle ScholarPubMed
4.McGowan, JE Jr, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997;11:297–311.CrossRefGoogle ScholarPubMed
5.Gerberding, JL, McGowan, JE, Tenover, FC. Emerging nosocomial infections and antimicrobial resistance. In: Remington, JS, Schwartz, MN, eds. Current Clinical Topics in Infectious Diseases. Boston: Blackwell Science; 1999.Google Scholar
6.Marr, JJ, Moffet, HL, Kunin, CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 1988;157:869–876.CrossRefGoogle ScholarPubMed
7.Carling, PC, Fung, TK, Coppola, PG, O'Donnell, FP. The use of a standardized antibiotic monitoring program to document cost savings. Presented at the 31st Annual Meeting of the Infectious Diseases Society of America; October 15-17, 1993; New Orleans, LA. Abstract 102.Google Scholar
8.Carling, PC, Fung, T, Killion, A, Barza, M. The favorable impact of the multi-disciplinary antibiotic management program analyzed over seven years. Presented at the 40th Interscience Conference on Antimicrobial Agents in Chemotherapy; September 16-20, 2000; Toronto, Ontario, Canada. Abstract 2131.Google Scholar
9.Shlaes, DO, Gerding, DN, John, JF, et al.Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 1997;25:584–599.CrossRefGoogle Scholar
10.Fishman, NO. Antimicrobial management and cost containment. In: Mandeli, JL, Bennet, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases, 5th ed. New York: Plenum; 2000:539–546.Google Scholar
11.Briceland, LL, Nightingale, CH, Quintiliani, R, Cooper, BW, Smith, KS. Antibiotic streamlining from combination therapy to monotherapy utilizing an interdisciplinary approach. Arch Intern Med 1988;148:2019–2022.CrossRefGoogle ScholarPubMed
12.Schaffner, W, Ray, WA, Federspiel, F, Miller, WO. Improving antibiotic prescribing in office practice: a controlled trial of three educational methods. JAMA 1983;250:1728–1732.CrossRefGoogle Scholar
13.Avorn, J, Soumerai, SB. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based “detailing.” N Engl J Med 1983;308:1457–1463.CrossRefGoogle ScholarPubMed
14.Fridkin, SK, Steward, CD, Edwards, JR, et al.Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: Project I CARE phase 2. Clin Infect Dis 1999;29:245–252.CrossRefGoogle ScholarPubMed
15.Hearst Corporation. First Databank Blue Book of Pharmaceuticals. New York: Hearst Corp.; 1994.Google Scholar
16.Carling, PC, Fung, T, Coldiron, JS. Parenteral antibiotic use in acute-care hospitals: a standardized analysis of fourteen institutions. Clin Infect Dis 1999;29:1189–1196.Google ScholarPubMed
17.Shanholtzer, CJ, Willard, KE, Holter, JJ, et al.Comparison of the VIDAS Clostridium difficile toxin A immuno assay with C-difficile culture and cytotoxin and latex tests. J Microbiol 1992;30:1837–1840.Google Scholar
18.Bender, BS, Bennett, R, Laughon, BE, et al.Is Clostridium difficile endemic in chronic-care facilities? Lancet 1986;2:11–13.CrossRefGoogle ScholarPubMed
19.Fekety, R, Kim, KH, Brown, D, Batts, DH, Cudmore, M, Silva, J Jr. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment. Am J Med 1981;70:906–908.CrossRefGoogle ScholarPubMed
20.Katz, GW, Gitlin, SD, Schaberg, DR, et al.Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:128–194.Google Scholar
21.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
22.Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(RR-12):1–13.Google Scholar
23.McGowan, JE Jr, Finland, M. Usage of antibiotics in the general hospital: effect of requiring justification. J Infect Dis 1974;130:165–168.CrossRefGoogle ScholarPubMed
24.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471–485.CrossRefGoogle ScholarPubMed
25.Coleman, RW, Rodondi, LC, Kaubisch, S, Granzella, NB, O'Hanley, PD. Cost-effectiveness of prospective and continuous parenteral antibiotic control: experience at the Palo Alto Veteran's Affairs Medical Center from 1987 to 1989. Am J Med 1991;90:439–444.CrossRefGoogle Scholar
26.Quale, J, Landman, D, Saurina, G, Atwood, E, DiTore, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.CrossRefGoogle ScholarPubMed
27.Burke, J. Antibiotic resistance: squeezing the balloon? JAMA 1998;289:1270–1271.Google Scholar
28.Polk, R. Optimal use of modern antibiotics: emerging trends. Clin Infect Dis 1999;29:264–274.CrossRefGoogle ScholarPubMed
29.Frank, M, Betteiger, B, Sorensen, S, et al.Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clinical Performance and Quality Healthcare 1997;5:180–188.Google ScholarPubMed
30.White, AC, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SV. Effect of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities and clinical outcomes. Clin Infect Dis 1997;25:30–39.CrossRefGoogle ScholarPubMed
31.Fraser, GL, Stogsdill, P, Dickens, JD Jr, Wennberg, DE, Smith, RP Jr, Prato, BS. Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1997;157:1689–1694.CrossRefGoogle ScholarPubMed
32.Pestotnik, SL, Classen, DC, Evans, RS, Burke, JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884–890.CrossRefGoogle ScholarPubMed
33.Evans, RS, Pestotnik, SL, Classen, DC, et al.A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232–238.CrossRefGoogle ScholarPubMed
34.Johnson, S, Gerding, DN. Clostridium difficile. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore: Williams and Wilkins; 1996:399–408.Google Scholar
35.Johnson, S, Gerding, DN, Olson, MM, et al.Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1989;88:137–140.CrossRefGoogle Scholar
36.Brooks, SE, Veal, RO, Kramer, M, Dore, L, Schupf, N, Adachi, M. Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following the replacement of electronic thermometers with single-use disposables. Infect Control Hosp Epidemiol 1992;13:98–103.CrossRefGoogle Scholar
37.Pear, SM, Williamson, TH, Bettin, KM, Gerding, DN, Galgiani, JN. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 1994;120:272–277.CrossRefGoogle ScholarPubMed
38.Brown, E, Talbot, GH, Axelrod, P, Provencher, M, Hoegg, C. Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol 1990;11:283–290.CrossRefGoogle ScholarPubMed
39.Climo, MW, Israel, DS, Wong, ES, Williams, D, Coudron, P, Markowitz, SM. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989–995.CrossRefGoogle ScholarPubMed
40.Murphy, P, LeClair, J. Incidence of Clostridium difficile-associated disease following therapy with either ceftriaxone or ticarcillin-clavulanate. Presented at the 37th Interscience Conference on Antimicrobial Agents and Chemotherapeutics; September 18-22, 1996; New Orleans, LA. Abstract J40.Google Scholar
41.Rahal, JJ, Urban, C, Horn, D, et al.Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998;280:1233–1237.CrossRefGoogle ScholarPubMed
42.Rice, LB, Eckstein, EC, DeVente, J, Shales, DM. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996;23:118–124.CrossRefGoogle ScholarPubMed
43.Landman, D, Chockalingam, M, Quale, JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis 1999;28:1062–1066.CrossRefGoogle Scholar
44.Paterson, DL, Yu, VL. Extended-spectrum beta lactamases: a call for improved detection and control. Clin Infect Dis 1999;29:1419–1422.CrossRefGoogle Scholar
45.Hayden, MK. Insights into the epidemiology and control of infection with vancomycin-resistant enterococci. Clin Infect Dis 2000;31:1058–1065.CrossRefGoogle ScholarPubMed
46.Donskey, CJ, Chowdhry, TK, Hecker, MT, et al.Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.Google Scholar
47.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effective parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 1999;180:384–390.CrossRefGoogle ScholarPubMed
48.Lautenbach, E, LaRosa, LA, Marr, AM, Nachamkin, I, Bilker, WB, Fishman, NO. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions: impact of progressive restrictions on use of vancomycin and third-generation cephalosporins. Clin Infect Dis 2003;36:440–446.CrossRefGoogle ScholarPubMed
49.Rice, LB. A silver bullet for colonization and infection with methicillin resistant Staphylococcus aureus still eludes us. Clin Infect Dis 1999;28:1067–1070.CrossRefGoogle Scholar
50.Wenzel, RP, Wong, MT. Managing antibiotic use: impact of infection control. Clin Infect Dis 1999;28:1126–1127.CrossRefGoogle ScholarPubMed
51.Farr, BM, Jarvis, WR. Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? Infect Control Hosp Epidemiol 2002;23:65–68.CrossRefGoogle ScholarPubMed
52.Jones, RN, Marchall, SA, Pfaller, MA, et al.Nosocomial enterococcal blood stream infections in the SCOPE Program: antimicrobial resistance, species occurrence, molecular testing results, and laboratory testing accuracy. Diagn Microbiol Infect Dis 1997;29:95–102.CrossRefGoogle ScholarPubMed
53.Low, DE, Keller, N, Barth, A, Jones, R. Clinical prevalence, antimicrobial susceptibility and geographic resistance patterns of enterococci: results from the SENTRY antimicrobial resistance surveillance program 1997-1999. Clin Infect Dis 2001;32(suppl 2):S133–S145.CrossRefGoogle ScholarPubMed