Impact of a Hospital‐Based Antimicrobial Management Program on Clinical and Economic Outcomes

TLDR

Inappropriate antimicrobial use causes excess exposure, persistent infection, resistance, and higher costs. The study aimed to implement a program that controls restricted agent use while improving patient care. The program compared recommendations from an Antimicrobial Management Team (pharmacist and ID physician) to those from ID fellows, evaluating appropriateness, cure rate, treatment failures, and cost in 180 patients. The Antimicrobial Management Team achieved higher appropriateness (87% vs 47%), cure rate (64% vs 42%), and lower treatment failures (15% vs 28%) than ID fellows, though cost differences were not significant.

Abstract

Inappropriate use of antimicrobial agents results in unnecessary exposure to medication, persistent or progressive infection, emergence of resistance, and increased costs. We implemented a program to control use of restricted agents while improving care. This study compared 2 major mechanisms for improving use of antimicrobial agents: (1) recommendations made by the Antimicrobial Management Team (AMT), which included a clinical pharmacist backed up by a physician from the Division of Infectious Diseases (ID), and (2) recommendations made by ID fellows. Outcome measures included appropriateness of recommendations, cure rate, number of treatment failures, and cost of care, which were assessed for 180 patients. The AMT outperformed the ID fellows in all outcomes examined by the study (including appropriateness [87% vs. 47%; P<.001], cure rate [64% vs. 42%; P=.007], and treatment failures [15% vs. 28%; P=.03]), although the differences in economic outcomes between cases managed by the AMT and those managed by the ID fellows were not statistically significant. In an academic setting with a restricted formulary, the AMT demonstrated better antimicrobial prescribing than ID fellows.