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Author Notes:

Correspondence and Reprint requests should be directed to: Henry M. Blumberg, MD, Emory University School of Medicine, Division of Infectious Diseases, 49 Jesse Hill Dr, Atlanta, GA 30303, henry.m.blumberg@emory.edu, Phone: (404) 727-5096, Fax: (404) 727-5021

Current affiliations: Dr. Camins is now in the Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO. Dr. King is at the Beacon Center for Infectious Diseases, Boulder, CO. Dr. Wells is a Clinical Pharmacist Specialist at the Johns Hopkins Hospital, and Dr. Googe is employed by Bristol Myers Squibb in Atlanta, GA. The affiliations for Drs. Patel, Kourbatova and Blumberg are unchanged and are as listedon the title page.

Bernard C. Camins, M.D. is on the Speaker’s Bureau for Wyeth Pharmaceuticals. The other authors have no potential conflicts of interest to disclose.


Research Funding:

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.).

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


Journal Title:

Infection Control and Hospital Epidemiology


Volume 30, Number 10


, Pages 931-938

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2009 by The Society for Healthcare Epidemiology of America. All rights reserved.

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