Antimicrobial Stewardship in a Long Term Acute Care Hospital

Silvia Corcione

An antimicrobial stewardship (AS) program was established at New England Sinai Hospital, a 212-bed long term acute care hospital (LTACH) in Massachusetts using the electronic medical record to conduct daily audits, with interventions made via e-mail.
We conducted an interrupted series analysis to measure the impact of the invention on hospital-acquired C. difficile infection (HA-CDI) rates and antimicrobial utilization, quantified by defined daily dose (DDD) and normalized to 1000 PD. Pre-implementation period was from April 2010 to March 2011,implementation was in April 2011,and post-implementation period was from April 2011 to March 2014.
During the pre-implementation period, total antimicrobial usage was 266 DDD/1000 PD and rose 4.54(95% CI -0.19 to 9.28) per month, then there was a significant decline from the pre-implementation to post-implementation period (-6.58 DDD/ 1000 PD; 95% CI -11.48 to -1.67; p=0.01). The same trend was observed for anti MRSA (-2.97 DDD/ 1000 PD; 95% CI -5.65 to -0.30; p=0.03). There was a drop in usage of anti CDI antibiotics by 50.4 DDD/ 1000 PD (95% CI -71.4-29.2; p<0.001) at the time of program implementation, that was maintained afterwards. Anti Pseudomonas antibiotics increased after starting the implementation (30.6 DDD/ 1000 PD; 95% CI 4.9-56.3; p=0.02) but with ongoing education there was a 9% reduction from baseline. Intervention was associated with HA-CDI drop (Incidence Rate Ratio 0.57; 95% CI, 0.35-0.92; p=0.02).

Simone Agnello
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