Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years

Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706. doi: 10.1086/502278.

Abstract

Objective: To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years.

Design: Prospective study with comparison with preintervention trends.

Setting: University-affiliated teaching hospital.

Patients: All adult inpatients.

Intervention: A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size.

Results: Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P = .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates.

Conclusion: These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.

Publication types

  • Evaluation Study

MeSH terms

  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Cephalosporins / economics
  • Cephalosporins / therapeutic use
  • Clostridium difficile / drug effects*
  • Clostridium difficile / pathogenicity*
  • Cross Infection
  • Drug Resistance, Bacterial
  • Enterococcus / drug effects
  • Enterococcus / pathogenicity
  • Enterocolitis, Pseudomembranous / drug therapy*
  • Enterocolitis, Pseudomembranous / economics
  • Enterocolitis, Pseudomembranous / transmission
  • Hospitals, Teaching / statistics & numerical data
  • Humans
  • Methicillin Resistance
  • Patient Care Team
  • Population Surveillance
  • Prospective Studies
  • Staphylococcal Infections / drug therapy

Substances

  • Anti-Bacterial Agents
  • Cephalosporins