Major Article
Implementing an antibiotic stewardship program at a long-term acute care hospital in Detroit, Michigan

https://doi.org/10.1016/j.ajic.2017.07.028Get rights and content

Background

The objective of the study was to assess health care providers' (HCPs) knowledge and attitude toward antimicrobial resistance (AMR) and implement an antimicrobial stewardship program (ASP) in a long-term acute care hospital (LTACH).

Methods

A questionnaire on antibiotic use and resistance was administered to HCP in an LTACH in Detroit, Michigan, between August 2011 and October 2011. Concurrently, a retrospective review of common antibiotic prescription practices and costs was conducted. Then, a tailored ASP was launched at the LTACH followed by 2-phase postimplementation assessment aiming at evaluating the impact of the ASP on antibiotic expenditure.

Results

Of all respondents (N = 26), 65% viewed AMR as a national problem, but only 38% perceived AMR as a problem at their facility. Most respondents were familiar with infections caused by resistant organisms such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase; however, only 35% expressed confidence in treating infected patients. In the preimplementation phase, 15% of antimicrobial doses were inappropriate and 10 of 13 de-escalation opportunities were missed, resulting in additional $23,524.00 expenditure. In the first postimplementation phase, there was a 42% and 58% decrease in the use of daptomycin and tigecycline, respectively, resulting in $55,000 savings. In the second postintervention phase, total antimicrobial cost for treating a cohort of 28 patients in 2016 and 2017 was $26,837.85 and $22,397.15, respectively.

Conclusions

Introduction of an ASP in an LTACH improves antimicrobial prescribing practices, reduces cost, and is sustainable.

Section snippets

Background

Based on the overwhelming evidence that implementation of antimicrobial stewardship programs (ASPs) in health care settings limits antimicrobial resistance (AMR), improves treatment efficacy, and reduces treatment-related costs, the Joint Commission (JC) developed antimicrobial stewardship standards that became effective on January 1, 2017.1 Compliance with the standards requires hospitals to establish an evidence-proven ASP as an organizational priority.1

Long-term acute care hospitals (LTACHs)

Methods

The study was conducted at a 76-bed LTACH in metropolitan Detroit, Michigan, and was approved by the ethics committee.

HCP survey

Twenty-six HCP, including physicians, physician assistants, nurses, nurse practitioners, pharmacists, and infection control practitioners, participated in the survey. Seventeen HCP strongly agreed that AMR was a national problem, 16 strongly agreed that it was a problem in long-term care facilities, and 10 strongly agreed that it was a problem at their facility.

Twenty-one respondents were familiar with infections caused by methicillin-resistant Staphylococcus aureus and vancomycin-resistant

Discussion

Our study assessed knowledge, attitude, and perception of antibiotic use and resistance among HCP, while implementing a successful and sustainable ASP tailored for an LTACH.

Our survey showed that 17 of 26 HCP (65%) strongly agreed that AMR was a national problem; however, only 10 (38%) strongly agreed that it was a problem at their own facility. This indicates that HCP are generally aware of the growing problem of AMR, but they often underestimate the magnitude of the problem at their own

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Conflicts of interest: None to report.

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