Skip to main content
×
Home
    • Aa
    • Aa

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

  • Philip Carling (a1) (a2) (a3), Teresa Fung (a1), Ann Killion (a1), Norma Terrin (a3) and Michael Barza (a1) (a3)...
Abstract
AbstractObjective:

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.

Copyright
Corresponding author
Infectious Diseases Section, Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. CM Kunin , T Tupasi , WA Craig . Use of antibiotics: a brief exposition of the problem and some tentative solutions. Ann Intern Med 1973:79:555560.

3. CM Kunin . The responsibility of the infectious disease community for the optimal use of antimicrobial agents. J Infect Dis 1985;151:388398.

4. JE McGowan Jr, FC Tenover . Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997;11:297311.

6. JJ Marr , HL Moffet , CM Kunin . Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 1988;157:869876.

9. DO Shlaes , DN Gerding , JF John , 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;25:584599.

11. LL Briceland , CH Nightingale , R Quintiliani , BW Cooper , KS Smith . Antibiotic streamlining from combination therapy to monotherapy utilizing an interdisciplinary approach. Arch Intern Med 1988;148:20192022.

12. W Schaffner , WA Ray , F Federspiel , WO Miller . Improving antibiotic prescribing in office practice: a controlled trial of three educational methods. JAMA 1983;250:17281732.

13. J Avorn , SB Soumerai . Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based “detailing.” N Engl J Med 1983;308:14571463.

14. SK Fridkin , CD Steward , JR Edwards , et al.Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: Project I CARE phase 2. Clin Infect Dis 1999;29:245252.

16. PC Carling , T Fung , JS Coldiron . Parenteral antibiotic use in acute-care hospitals: a standardized analysis of fourteen institutions. Clin Infect Dis 1999;29:11891196.

19. R Fekety , KH Kim , D Brown , DH Batts , M Cudmore , J Silva Jr. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment. Am J Med 1981;70:906908.

21. JS Garner , WR Jarvis , TG Emori , TC Horan , JM Hughes . CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.

23. JE McGowan Jr, M Finland . Usage of antibiotics in the general hospital: effect of requiring justification. J Infect Dis 1974;130:165168.

24. JF John Jr, NO Fishman . Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471485.

25. RW Coleman , LC Rodondi , S Kaubisch , NB Granzella , PD O'Hanley . 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;90:439444.

26. J Quale , D Landman , G Saurina , E Atwood , V DiTore , K Patel . Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:10201025.

28. R Polk . Optimal use of modern antibiotics: emerging trends. Clin Infect Dis 1999;29:264274.

30. AC White , RL Atmar , J Wilson , TR Cate , CE Stager , SV Greenberg . Effect of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities and clinical outcomes. Clin Infect Dis 1997;25:3039.

31. GL Fraser , P Stogsdill , JD Dickens Jr, DE Wennberg , RP Smith Jr, BS Prato . Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1997;157:16891694.

32. SL Pestotnik , DC Classen , RS Evans , JP Burke . Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884890.

33. RS Evans , SL Pestotnik , DC Classen , et al.A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232238.

35. S Johnson , DN Gerding , MM Olson , et al.Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1989;88:137140.

36. SE Brooks , RO Veal , M Kramer , L Dore , N Schupf , M Adachi . 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;13:98103.

37. SM Pear , TH Williamson , KM Bettin , DN Gerding , JN Galgiani . Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 1994;120:272277.

39. MW Climo , DS Israel , ES Wong , D Williams , P Coudron , SM Markowitz . Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989995.

41. JJ Rahal , C Urban , D Horn , et al.Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998;280:12331237.

42. LB Rice , EC Eckstein , J DeVente , DM Shales . Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996;23:118124.

43. D Landman , M Chockalingam , JM Quale . 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;28:10621066.

44. DL Paterson , VL Yu . Extended-spectrum beta lactamases: a call for improved detection and control. Clin Infect Dis 1999;29:14191422.

45. MK Hayden . Insights into the epidemiology and control of infection with vancomycin-resistant enterococci. Clin Infect Dis 2000;31:10581065.

46. CJ Donskey , TK Chowdhry , MT Hecker , et al.Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:19251932.

47. CJ Donskey , JA Hanrahan , RA Hutton , LB Rice . Effective parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 1999;180:384390.

48. E Lautenbach , LA LaRosa , AM Marr , I Nachamkin , WB Bilker , NO Fishman . 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;36:440446.

49. LB Rice . A silver bullet for colonization and infection with methicillin resistant Staphylococcus aureus still eludes us. Clin Infect Dis 1999;28:10671070.

50. RP Wenzel , MT Wong . Managing antibiotic use: impact of infection control. Clin Infect Dis 1999;28:11261127.

52. RN Jones , SA Marchall , MA Pfaller , 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;29:95102.

53. DE Low , N Keller , A Barth , R Jones . 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):S133S145.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 12 *
Loading metrics...

Abstract views

Total abstract views: 210 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th May 2017. This data will be updated every 24 hours.