Antimicrobial stewardship programs (ASPs) reduce inappropriate antimicrobial use and produce cost savings for hospitals; they also improve quality of care and patient safety. How can you tell how your antimicrobial stewardship program is performing? In addition to improving common metrics such as antimicrobial use and pharmacy costs, high-performing antimicrobial stewardship programs also monitor outcomes such as:
Rates of Clostridium difficile (C. dif.) infections: Because hospital-acquired Clostridium difficile is highly associated with prior antimicrobial use, C. diff. rates typically drop following introduction of an ASP. Most hospitals already report C. diff. infection rates to the National Healthcare Safety Network (NHSN) as part of the Centers of Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program.
The number of patients who develop multidrug-resistant infections following admission: While resistant strains of many pathogens have proved durable, even as antimicrobial prescription patterns change, a number of hospitals have found lower rates of methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae healthcare-associated infections (HAIs) following introduction of antimicrobial stewardship efforts.
The number of hospital readmissions: By reducing the risk of undetected HAIs and post-hospitalization C. diff. infections, antimicrobial stewardship programs can decrease the number of hospital readmissions shortly after discharge. Researchers at Skane University Hospital in Malmo, Sweden, and others have reported that antimicrobial stewardship programs decreased antibiotic use and reduced hospital readmissions due to infection without increasing mortality rates.1
Infection-related mortality rates: Better drug-bug matches, more appropriate use of antimicrobials, more culture-based prescribing and lower rates of healthcare-associated infections (HAIs) contribute to patient safety. Hospitals with robust ASPs have seen increased cure rates and decreased treatment failure rates for infections and reduced incidence of bacteremia, gram-negative infection and antimicrobial drug-related adverse events.2 Infectious disease specialists involved in antimicrobial stewardship programs name infection-related mortality rates as the most important outcome to track in any antimicrobial stewardship program.3
Infection or antimicrobial-associated length of stay: Fewer HAIs mean shorter hospitalizations and fewer antimicrobial side effects also lead to earlier discharges. On average, an HAI extends a patient’s hospital stay by 9.58 days, the cost of which is largely non-reimbursable by Medicare and most private insurance.4
1 American Society for Microbiology. Antibiotic stewardship programs reduce costs, improve outcomes. 6 Sept. 2014.
2 Ohl C, Dodds Ashley E. Antimicrobial Stewardship Programs in Community Hospitals: The Evidence Base and Case Studies. Clin Infect Dis. (2011) 53(Supplement 1):S23-S28.
3 Bumpass J. McDaneld P, DePestel D, Lamp K, Chung T, McKinnon P, Crompton M, Hermsen E. Antimicrobial Stewardship: Patients Over Process. Clin Infect Dis. (2014) 59(Supplement 3):S108-S111.
4 Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 2003;290:1868-74.