The Impact of an Antimicrobial Utilization Program on Antimicrobial Use at a Large Teaching Hospital: A Randomized Controlled Trial

• Type of Material: Article
• Authors: Bernard C. Camins, Emory University; Mark D. King, Emory University; Jane B. Wells, Grady Memorial Hospital; Heidi L. Googe, Grady Memorial Hospital; Manish Patel, Grady Memorial Hospital; Ekaterina V. Kourbatova, Emory University; Henry Michael Blumberg, Emory University
• Language: English
• Date: 2009-10
• Publisher: Cambridge University Press (CUP): STM Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2009 by The Society for Healthcare Epidemiology of America. All rights reserved.
• Final Published Version (URL): http://www.jstor.org/stable/10.1086/605924
• Title of Journal or Parent Work: Infection Control and Hospital Epidemiology
• ISSN: 0899-823X
• Volume: 30
• Issue: 10
• Start Page: 931
• End Page: 938
• Grant/Funding Information: Emory Medical Care Foundation (to M.D.K.) and the National Institutes of Health (UL1RR024992 to B.C.C., K12 RR017643 to M.D.K. and H.M.B., K23 AI054371 to M.D.K., and UL1 RR025008 to H.M.B.).
• Keywords: vancomycin; intervention trial; antimicrobial use; antimicrobial utilization teams; efficacy; university-affiliated hospital; levofloxacin; piperacillin-tazobactam; teaching hospital
• Research Categories: Health Sciences, General; Health Sciences, Epidemiology; Health Sciences, Pharmacology

Abstract

Background Multidisciplinary antimicrobial utilization teams (AUT) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited. Objective To determine the impact of an AUT on antimicrobial use at a teaching hospital. Design Randomized controlled intervention trial. Setting A 953-bed public university-affiliated urban teaching hospital. Patients Patients who were prescribed selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams. Intervention Twelve internal medicine teams were randomized monthly: 6 teams to intervention group (academic detailing by the AUT), and 6 teams to a control group given indication-based guidelines for prescription of broad spectrum antimicrobials (standard of care) during a 10-month study period. Measurements Proportion of appropriate empiric, definitive (therapeutic), and end antimicrobial (overall) usage. Results A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of appropriate antimicrobial prescriptions written by the intervention teams was significantly higher than prescribed by the control teams: 82% vs. 73% for empiric (RR=1.14, 95% CI 1.04–1.24), 82% vs. 43% for definitive (RR=1.89, 95% CI 1.53–2.33), and 94% vs. 70% for end antimicrobial usage (RR=1.34, 95% CI 1.25–1.43). In a multivariate analysis, teams that received feedback from the AUT alone (aRR=1.37, 95% CI 1.27–1.48) or from both the AUT and the ID consult service (aRR=2.28, 95% CI 1.64–3.19) were significantly more likely to prescribe end antimicrobial usage appropriately compared to control teams. Conclusions A multidisciplinary AUT which provides feedback to prescribing physicians was an effective method in improving antimicrobial use.