Do Inpatient Antimicrobial Stewardship Programs help us in the Battle against Antimicrobial Resistance?

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Sara Y TartofLei Qian

Abstract

Antibiotic stewardship programs (ASPs) have demonstrated success at reducing costs, yet there is limited quality evidence of their effectiveness to reduce infections of high-profile drug-resistant organisms. This retrospective cohort study included all Kaiser Permanente Southern California (KPSC) members hospitalized in 9 KPSC hospitals aged ≥18 years from January 1, 2008 to December 31, 2016. We measured the impact of staggered ASP implementation on consumption of 18 ASP-targeted antibiotics using generalized linear mixed effects models. We used multivariable generalized linear mixed effects models to estimate the adjusted effect of ASP on rates of infection with drug-resistant organisms. Analyses were adjusted for confounding by time, cluster effects, and patient-level and hospital-level characteristics. We included 765,111 hospitalizations (288,257 pre-ASP, 476,854 post-ASP). By defined daily dose, we found a 6.1% (-7.5% - -4.7%) overall decrease in use of antibiotics post-ASP, and by days of therapy, we detected a 4.3% (-5.4% - -3.1%) decrease in overall use of antibiotics. The number of prescriptions increased post-ASP (1.04 [1.03-1.05]). In adjusted analyses, we detected an overall increase of VRE infection following ASP ...Continue Reading

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