Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program Author(s): Harold C. Standiford, Shannon Chan, Megan Tripoli, Elizabeth Weekes, Graeme N. Forrest Reviewed work(s): Source: Infection Control and Hospital Epidemiology, Vol. 33, No. 4, Special Topic Issue: Antimicrobial Stewardship (April 2012), pp. 338-345Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/664909 . Accessed: 16/03/2012 20:01
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infection control and hospital epidemiology
april 2012, vol. 33, no. 4
Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program
Harold C. Standiford, MD;1,2 Shannon Chan,PharmD;3 Megan Tripoli, BA;1 Elizabeth Weekes, PharmD;4 Graeme N. Forrest, MBBS5
background. An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of ﬁscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases–trained clinical pharmacist and a part-timeinfectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship. design. A descriptive cost analysis before, during, and after theprogram. patients/setting. A large tertiary care teaching medical center. methods. Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY. results. The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There wasa reduction of approximately $3 million within the ﬁrst 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center,mostly in the antibacterial category. conclusions. 7-year period. The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this Infect Control Hosp Epidemiol 2012;33(4):338-345
Antimicrobial resistance is increasing throughout the United States. Furthermore, there are fewer new antimicrobials being developed to treat these resistantorganisms.1 This has led the Infectious Diseases Society of America, the Society for Health Care Epidemiology, and the Centers for Disease Control and Prevention to recommend that hospitals develop antimicrobial stewardship programs (ASPs) to help protect our existing armamentarium as long as possible.2 Despite this recommendation, many medical centers have not established active programs. Such...
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