Infection guidelines lower costs and resistance
Infection guidelines lower costs and resistance
Detroit program shows three-fold benefit
The implementation of clinical practice guidelines for infections in a medical intensive care unit decreased antibiotic costs, bacterial resistance rates, and patient lengths of stay, report researchers at William Beaumont Hospital in Detroit.
’We not only reduced the cost of care, but also rates of nosocomial infections and rates of antibiotic resistance in some of our more important gram-negative bacteria,” says Mark Cervos, MD, epidemiologist at the hospital and clinical associate professor at Wayne State University School of Medicine.
The guidelines, or ’clinical pathways,” lowered antibiotic costs by some 50% after only three months of implementation, and decreased bacterial resistance rates for Pseudomonas aeruginosa, Enterobacter aerogenes, and Klebsiella pneumoniae.
’The costs savings related to the antibiotic use went from about $62,000 down to about $32,000 just in acquisition costs alone,” says co-researcher Alison Brooks, MD, a resident in internal medicine at the hospital, who presented the findings recently in New Orleans at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). ’Susceptibility to all antibiotics basically improved across the board.”
Buoyed by the initial success in the ICU, the program is now being expanded hospitalwide, the clinicians tell Hospital Infection Control.
Hospital expects staggering savings’
’Just in terms of the antibiotic savings alone, we have the potential for hundreds of thousands of dollars in savings annually,” Cervos says. ’If you factor in nosocomial infections and changes in resistance rates it is a really staggering savings that can result from this type of approach.”
Under the program a multidisciplinary team developed clinical practice guidelines for six major infections: respiratory tract, urinary tract, intra-abdominal, IV catheter infection, sepsis of undetermined etiology, and complicated soft tissue.
All patients in the ICU over a seven-month period were studied, with a four-month baseline period and then three months of data collection after implementation of the pathways. During the baseline period there were 33 nosocomial infections in 158 patients (1426 patient days), and 70% of patients were colonized with gram-negative bacteria. Following implementation of the clinical pathways, nosocomial infections in the ICU fell to 20 in 180 patients (1578 patient days) and 42% of patients were colonized with gram-negative bacteria. Average length of stay in the ICU declined from 8 days to 5.5 days.
’Length of stay was shorter so people were in the ICU and [exposed] to nosocomial infections for less time,” Brooks says. ’Secondly, I think we did change the flora in the ICU to less resistant organisms.”
Pharmacy feedback critical
During the study period, pharmacy staff, critical care physicians, and other members of the effort did rounds together to help enforce the guidelines, Brooks notes.
’That actually made quite a difference,” she says. ’If an antibiotic from a non-guideline group was chosen then pharmacy would call and redirect the attending physician toward the guidelines. Prior to this there were really no restrictions placed on antibiotics. ’
The practice guidelines provided recommendations for antibiotic administration, selection of antibiotics, how long they should be given, diagnostic tests, and follow-up of patients, Cervos notes. The goal was to try to limit the overall amount of antibiotics used and to direct practitioners to specific classes penicillins, for example to stave off resistance and cut costs.
’We recommended switching antibiotics once the results of cultures were available, to the most narrow-spectrum, least expensive antibiotic that the organism would be susceptible to,” he says. ’It is important to let others interested in this know that the feedback mechanism which in our case involved pharmacy was an essential part of this. Having practice guidelines that sit in somebody’s office wouldn’t be as successful.”
Indeed, another study presented at ICAAC underscored the importance of pharmacy oversight in curtailing inappropriate antibiotic use at the University of California, San Francisco. The researchers analyzed data collected from the antimicrobial monitoring program at the UCSF Medical Center from May 1994 through April 1996. They projected that between 25 and 111 additional patients were cured of infections as a result of pharmacy interventions, reports B. Joseph Guglielmo, PharmD, professor and vice-chair of the department of clinical pharmacy at the UCSF School of Pharmacy.
’Antimicrobial monitoring programs are common at academic medical centers, but they are not as well-established throughout the hospital industry, which I think is unfortunate,” Guglielmo says. ’These programs can benefit patients by helping to ensure that treatment is both safe and effective. Prescription monitoring can be cost-effective, because better treatment can circumvent complications and shorten hospital stays.”
Overall, changes were recommended in about 6% percent of the antibiotic prescriptions sent to the hospital pharmacy. During the two-year period, monitoring pharmacists and infectious-disease physicians intervened a total of 3,344 times. Of these, 858 interventions were classified as ’high level,” including 471 instances in which pharmacists made recommendations to reduce the likelihood of drug toxicity, and 387 occasions when the pharmacists advocated changes they thought would increase the effectiveness of therapy.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.