Economic and Clinical Outcomes of Antimicrobial Stewardship Program Implementation at a Community Hospital Affiliated with a Regional Health System

BACKGROUND: Inova Fair Oaks Hospital (IFOH) is a 182-bed community hospital, associated with a large regional health system. The antimicrobial stewardship program (ASP) at IFOH is primarily led by an infectious disease physician and a clinical pharmacist. ASP was established in 2012 at IFOH. IFOH shared antimicrobial formulary and order-sets with the health system. METHODS: In 2015, ASP rounding structure was expanded to include retrospective review of all inpatient antibiotics. Additionally, the clinical pharmacist reviewed restricted antimicrobials and all vancomycin orders daily. For patients requiring interventions, the pharmacist communicated recommendations with the treating physicians. Primary objectives of the ASP team were reduction of inappropriate use of antibiotics and optimization of pharmacy vancomycin dosing guidelines. Clinical and economic data was compared with the 2014 baseline; the outcomes were reviewed for a 2-year period. During this time, the hospital infection control committee also launched a hand-washing campaign. RESULTS: Direct antimicrobial purchasing costs decreased from 2014 baseline of $852,835 per year to $754,335 in 2015 and $569,042 in 2016. An associated decrease in overall antibiotic utilization was observed, as measured by days of therapy per 1,000 patient-days. Baseline and current drug acquisition costs were reviewed; except for the reduction in linezolid cost, the purchasing cost change does not account for all cost savings realized by the ASP. During the 2-year period, the percentage of Staphylococcus aureus resistant to methicillin decreased from 42% to 38%. Additionally, improved antibiotic susceptibility or gram-negative organisms were noted. Specifically for Pseudomonas aeruginosa, susceptibility for aztreonam, cefepime, ciprofloxacin, and levofloxacin improved by an average of 20%. For Escherichia coli, quinolone susceptibility improved by an average of 7%. CONCLUSION: Expansion of ASP monitoring at a community hospital demonstrated favorable clinical and economic outcomes. The investment in personnel resources required to maintain ASP is offset by the clinical and economic benefit ASP provides. How long these beneficial effects are sustained remains to be determined. DISCLOSURES: All authors: No reported disclosures.