Clinical Impact of an Antibiotic Stewarship Program at Two Non-Teaching Community Hospitals

BACKGROUND: The clinical impact of antibiotic stewardship programs (ASP) in non-teaching community hospitals (NTCH) is largely unknown. We report our experience in two NTCH with limited resources where ASP was established. METHODS: In 2008, ASP was established at two NTCH: University of Maryland-Upper Chesapeake Medical Center (UM-UCMC) and University of Maryland-Harford Memorial Hospital (UM-HMH) each with 195 and 128 beds, respectively. Empiric use of Level 1 antibiotics (piperacillin/tazobactam and vancomycin) was restricted to 72 hours, after which a positive culture or an ID consult was required to continue the antibiotics further. Empiric use of Level 2 antibiotics (carbapenems, echinocandins, tigecycline, daptomycin, linezolid, ganciclovir, voriconazole, lipid amphotericin and other non-formulary antibiotics) required an ID consult within 24 hours. Pharmacists reviewed restricted antibiotics and culture results, managed drug levels of vancomycin and aminoglycosides, and facilitated IV to PO conversions. Annual antibiograms were generated. Antibiotic utilization, cost, resistance patterns and rates of healthcare-associated (HA) C. difficile infections were tracked. RESULTS: Rates of HA C. difficile infections decreased by 73%. Pseudomonas resistance to carbapenems, gentamicin, and piperacillin/tazobactam decreased by 62%, 56%, and 33% respectively. Enterococcus resistance to vancomycin, and the rates of extended spectrum β lactamase (ESBL) producing organisms remained stable. Total antibiotic purchase decreased by 30%; antibiotic cost per-patient-day decreased by an average of 41%. Physician compliance with our ASP was >90%. CONCLUSION: Implementing an ASP at two non-teaching community hospitals not just reduced the overall utilization and cost of antibiotics, but also resulted in a significant reduction of healthcare-associated C. difficile infections and pseudomonas resistance to carbapenems and aminoglycosides. DISCLOSURES: All authors: No reported disclosures.