An Antimicrobial Stewardship Initiative within a for-profit hospital: Impact of Criteria for Appropriate Use on Utilization

BACKGROUND: Antimicrobial Stewardship Programs (ASP) have shown improved patient outcomes, reduced adverse events, improved antibiotic susceptibilities, and optimized resource utilization. With the re-introduction of a formal ASP at our for-profit, non-teaching, community hospital in early 2016 in response to both legislative and corporate requirements, we sought to evaluate the impact of one of our ASP initiatives, Criteria for Appropriate Use, on utilization of three specific antimicrobial agents: Daptomycin (DAP), Tigecycline (TIG) and Ertapenem (ERT). The results of this investigation will help characterize various shifts in prescribing practices facilitated by an ASP initiative as well as quantify resultant trends in utilization. METHODS: This single-center, retrospective cohort study included patients who received DAP, TIG, or ERT in matched time periods: July – Sept 2015 (pre-ASP) and July – Sept 2016 (post-ASP). Patients were analyzed based on demographics, antibiotic use, days of therapy (DOT), indication (criteria for use), prescriber, infection type, and antibiotic course. Cost data and adjusted patient-days (APD) were extracted from hospital records. RESULTS: 644 cases were included. There were 555 pre-ASP cases per 31,884 APD: 128 (DAP), 368 (ERT), and 59 (TIG). In the post-ASP group, there were 89 cases per 30,960 APD: 40 (DAP), 39 (ERT), and 10 (TIG). Significant decreases were realized in the post-ASP period in: restricted antibiotic utilization (17.4 vs.. 2.9 cases/1000 APD, P < 0.0001), duration (58.2 vs. 14.3 DOT/1000 APD, P < 0.0001), off-criteria use (3.6 vs. 0.65 cases/1000 APD, P < 0.0001), and cost ($12.92 vs. $2.88/APD, P < 0.0001). CONCLUSION: The results of this study show that introduction of ASP, specifically Criteria for Appropriate Use implementation, was associated with not only significant decreases in utilization rates and antimicrobial cost, but significant shifts in prescriber behavior. DISCLOSURES: All authors: No reported disclosures.