Improving Antimicrobial Use at a University
Hospital: Results of the First Five Years of a Multidisciplinary
Antimicrobial Management Program
Craig Martin, Pharm.D., Robert Rapp, Pharm.D., Martin Evans,
M.D., Ardis Hoven, M.D., John Armistead, M.S., FSHP
University of Kentucky Chandler Medical Center
Lexington, Kentucky
Purpose
Antimicrobial control programs have been advocated in response
to inappropriate use and increasing antimicrobial resistance
among nosocomial pathogens, as well as escalating costs of
antimicrobial agents. During the mid-1990s, physicians in
infectious disease and clinical pharmacists at our institution
were becoming concerned about the increasing resistance rates
of key pathogens to commonly used antibiotics and the steady
increase in the pharmacy department’s annual expenditures
for anti-infective agents. These concerns led to a series
of initiatives aimed at controlling antimicrobial use for
the purpose of minimizing the development of antibiotic resistance
in nosocomial pathogens and reducing cost. We report the results
of the first five years (1998-2002) of an ongoing antimicrobial
control program in our institution.
Description of the Program
We initiated a formal antimicrobial control program at the
University of Kentucky Chandler Medical Center in 1998 with
the formation of a multidisciplinary antimicrobial subcommittee
of the pharmacy and therapeutics committee. Members of the
subcommittee included representatives from the disciplines
of surgery, pediatrics, internal medicine, transplant, critical
care, infectious diseases, pharmacy, and nursing. The antimicrobial
subcommittee was charged with the following responsibilities:
(1) to develop and implement initiatives to ensure the appropriate
use of antimicrobial agents by physicians in our institution
and (2) to review the existing formulary with the goal of
recommending more cost-effective antimicrobial choices that
would also reduce the selection of resistant nosocomial pathogens.
Key interventions included removal of ceftazidime and cefotaxime
from the formulary, introduction of cefepime and a combination
product containing piperacillin sodium and tazobactam sodium
to the formulary, restriction of vancomycin and carbapenem
use, and selection of a single fluoroquinolone agent. Subsequently,
our institution was able to justify the cost of hiring a pharmacist
(1.0 FTE) and physician (0.5 FTE) to lead this program.
Experience with the Program
Antimicrobial use was reduced by 80% for third-generation
cephalosporins and 15% for vancomycin following the implementation
of the new antimicrobial policies. Antimicrobial resistance
patterns for many important gram-negative pathogens, including
Pseudomonas aeruginosa, demonstrated a reversal of
previous increases. In addition, the rate of methicillin-resistant
Staphylococcus aureus was reduced an average of 3%
each year from 1999 to 2002. Pharmacy expenditures decreased
24.7% for all antimicrobial agents, including antiviral, antifungal,
and antibacterial agents, with a cumulative cost savings of
$1,401,126, without inflation assumptions. When a 10% inflation
rate is assumed, these cost savings escalate to $4,438,825.
Conclusion
A well-designed antimicrobial management program and team
has improved resistance rates in selected pathogens and resulted
in substantial cost savings at our institution.
|
