Impact of an antibiotic restriction policy on antibiotic usage and cost
Abstract number: 1133_31
Jover F., Cuadrado J., Ortiz de la Tabla V., Martin C., Sanchez V., Gonzalez M., Aznar T.
To assess the impact of a programme to evaluate the quality of an antibiotic restriction policy at a University hospital.
A multidisciplinary antimicrobial management team (AMT) composed by Infectious Diseases (ID),Microbiology and Pharmacy members daily evaluated restricted antibiotic prescriptions. We designed a prospective study with two periods:observational (Oct 1st 2003March 14th 2004) and interventional (March 15thSept 1st 2004). A specific prescription formulary aiming to evaluate the usage of broad spectrum antibiotics was introduced. Revision criteria were according to ID Committee guidelines and the Sanford Guide to Antimicrobial Therapy. Clinical, microbiological and pharmaceutical data were collected from each patient. Antibiotic therapy appropriateness, restricted therapy eligibility and economic outcomes were evaluated. During interventional period, antibiotic recommendation prescriptions were formulated. Statistical analysis with non-parametric tests were performed. A p value of <0.05 was accepted as significant.
480 patients were evaluated (54.3% observational and 45.7% interventional period). Overall, restricted agents prescribed were ceftazidime (27.9%), imipenem (24.8%), amikacin (14.6%), piperacilin-tazobactam (12.1%), vancomicin (6.5%) and cefepime (5%). Most frequent diagnostic groups were sepsis (40.3%), gastrointestinal (20.4%), respiratory (13.1%), soft-tissue and bone infections (12.9%) and prophylaxis (7.9%). Antibiotic therapy was not indicated in 7.1% of cases and the restricted antibiotherapy was suitable in 29.8%. Comparing both periods of study, we found several statistical significant features: a decrease of usage of ceftazime, amikacin, teicoplanin and piperacilin-tazobactam; however, imipenem and vancomicin usage increased. Adequate prescription of antibiotherapy increased from 81.7% to 96.8%. Restricted antibiotic prescription significantly improved from 58.5% to 86.3%, while concordance to AMT prescription increased from 53.3% to 78.5%. Economic outcomes were significantly reduced comparing both study periods. In the interventional period, recommendations were formulated in 38% of cases, while 70.2% of them were accepted.
The development of prophylactic and therapeutics local guidelines reached by consensus, and the evaluation and interventional policy by an AMT group have significantly improved the quality and economical costs of restricted antibiotic prescription in our hospital.
|Session name:||XXIst ISTH Congress|
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