Impact of a Antimicrobial Stewardship Program at the University of Minnesota Medical Center

Background:  On Jan. 2, 2007 we began a new Antimicrobial Management Team (AMT) at the University of Minnesota Medical Center and the Univ. of MN Children’s Hospital, Fairview (UMMC/UMCH), University Campus. The hospital is a 300 bed tertiary care facility on this campus. We present here the results of the first two years of interventions.

Objective: Our goals were to decrease inappropriate use of antibiotics, optimize antibiotic use, decrease nosocomial acquisition of antibiotic resistant bacterial infections or colonization and decrease Clostridium difficile diarrhea cases. In addition our goal was to decrease antimicrobial costs and provide more cost effective care.

Methods: The AMT program allows providers to order restricted antibiotics, according to our hospital guidelines, without upfront approval. But a retrospective chart review is done the following day, M-F, by a dedicated Pharm D and a M.D. with infectious disease expertise. Formal written recommendations are placed in the electronic medical record as an AMT note. Our previous restricted antibiotic program required the prescribing provider to get approval to use a restricted antibiotic from the on call ID doctor prior to use. Despite this we still saw inappropriate utilization and increasing costs. We planned to compare the outcome of the new AMT program to the old system.

 Results:

Antimicrobial Agents Activity University Campus	2005	2006	2007	2008
Antimicrobial Agents Total Costs	$5,712,589	$4,954,776	$4,841,578	$4,369,983
Total Patient Days	96,791	95,709	98,910	99, 090
Antimicrobial Agents Costs per Patient Day	$59.02	$51.77	$48.95	$44.37
Change	-	$7.25	$2.82	$4.58

The total cost saving for the first two years of the program is $732,758.  Costs savings has been impacted by drug contracting as well as a decrease in overall utilization.

AMT Interventions:

	Totals 2007	Totals 2008
# Patients	1143	1276
# Interventions	1991	2165
Accepts	1153 (57.9%)	1298 (60%)
Agree w/ Management	370 (18.6%)	407 (18.8%)
Declines	468 (23.5%)	460 (21.2%)

Infection Control Data:  patients with HA antibiotic resistant bacteria 2006-2008. HA-MRSA cases (infections and colonizations) from 2006 were 53 new patients, 2007 44 cases and 2008 47 cases.  HA-VRE cases 137 in 2006, 128 in 2007, 149 in 2008. HA-ESBL cases 7 in 2006, 12 in 2007 and 21 in 2008.  Clostridium difficile diarrhea rates for the study time period were as follows 2006 1.26/1000 patient days, 2007 (three quarters) 1.5/1000 patient days, and 2008 (2 quarters) 1.36/1000 patient days.

Conclusions:

Despite good acceptance of the AMT recommendations, reduced antibiotic use and significant cost saving we have not been able to show a consistent decrease in number of patients with hospital acquired (HA) antibiotic resistant bacteria.