Implementing antimicrobial stewardship in a community hospital

Purpose: Antimicrobial stewardship is defined as appropriate selection, dosing, route, and duration of antimicrobial therapy with a primary goal of optimizing clinical outcomes.  A significant amount of evidence has correlated pharmacist interventions with the appropriate use of antimicrobials.  The purpose of this study was to optimize antimicrobial use via pharmacy stewardship interventions.

Methods: This is an IRB approved, prospective review.  Patients > 18 years of age receiving IV antimicrobials for > 48 hours on a medical/surgical floor were included and reviewed during the months of November 2011 to January 2012.  Antimicrobial therapy was reviewed for appropriate indication, dose, route, and duration. Patients were excluded if they were immunocompromised, HIV positive, post-transplant, or pregnant.  The primary objective of this study was to assess pharmacist interventions on antimicrobial utilization, including the number and type of recommendations made and accepted by physicians. The secondary objective was to assess the cost savings associated with accepted interventions.

Results: A total of 340 patients were reviewed after screening for inclusion/exclusion criteria, 95 of these patients required therapy modification.  A total of 124 recommendations were made on 95 patients, of which 59 were automatic interventions.  Out of the remaining 65 recommendations made, 80% were accepted.  A total of 29 antimicrobials were discontinued on the basis of no infection present, antimicrobial course of therapy completed, or therapeutic duplication.  Furthermore, these interventions resulted in an estimated cost savings of $13,526 over the study period.

Conclusion: The number of interventions made during the study period supports the impact of a pharmacist-driven antimicrobial stewardship program in a community hospital.  In addition, pharmacy protocols for automatic intravenous to oral conversions and renal dose adjustments facilitate appropriate route and dosing of antibiotics.