Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.

M. O. Frank, B. E. Batteiger, S. J. Sorensen, A. I. Hartstein, J. A. Carr, J. S. McComb, C. D. Clark, S. R. Abel, J. M. Mikuta, R. B. Jones

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Abstract

OBJECTIVE: To evaluate changes in antimicrobial use and expenditures and the rates of selected nosocomial infections due to resistant organisms associated with implementation of an antimicrobial-prescribing improvement program. DESIGN: Before-after trial comparing 1992 (pre-program), 1993 (a transition year), and 1994 (after full implementation of the program). SETTING AND PARTICIPANTS: Academic medical center, all patients and physicians. INTERVENTION: An antimicrobial-prescribing improvement program with prior approval requirement for use of restricted agents. MAIN OUTCOME MEASURES: Antimicrobial use and expenditures, rates of selected nosocomial infection marker events. RESULTS: Between 1992 and 1994, there were substantial decreases in antimicrobial use, from 158,107 to 137,364 defined daily doses, and in expenditures from $2,486,902 ($24.01 per patient day) to $1,701,522 ($18.49 per patient day). After adjusting for changes in purchase prices and census days, we estimated savings attributable to the program of $279,573 in 1993 and $389,814 in 1994. In addition, we found significant decreases between 1992 and 1994 in the rates of enterococcal bacteremia (.34 vs .16 events per 1,000 patient days; P = .016), selected gram-negative bacteremia (.26 vs .11; P = .015), methicillin-resistant Staphylococcus aureus colonization or infection (.66 vs .20; P < .0001), and Stenotrophomonas colonization or infection (.35 vs .17; P = .019). No significant change occurred in rates of nosocomial candidemia or Clostridium difficile toxin-positive diarrhea. Values for 1993 were intermediate between those of 1992 and 1994. CONCLUSION: Implementation of an antimicrobial-prescribing improvement program was associated with substantial savings in antimicrobial use and expenditures and significant decreases in rates of selected nosocomial infections due to resistant organisms.

Original languageEnglish (US)
Pages (from-to)180-188
Number of pages9
JournalClinical performance and quality health care
Volume5
Issue number4
StatePublished - Jan 1 1997

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Cross Infection
Health Expenditures
Bacteremia
Stenotrophomonas
Candidemia
Clostridium difficile
Censuses
Methicillin-Resistant Staphylococcus aureus
Infection
Diarrhea
Physicians

ASJC Scopus subject areas

  • Medicine(all)

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Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. / Frank, M. O.; Batteiger, B. E.; Sorensen, S. J.; Hartstein, A. I.; Carr, J. A.; McComb, J. S.; Clark, C. D.; Abel, S. R.; Mikuta, J. M.; Jones, R. B.

In: Clinical performance and quality health care, Vol. 5, No. 4, 01.01.1997, p. 180-188.

Research output: Contribution to journalArticle

Frank, MO, Batteiger, BE, Sorensen, SJ, Hartstein, AI, Carr, JA, McComb, JS, Clark, CD, Abel, SR, Mikuta, JM & Jones, RB 1997, 'Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.', Clinical performance and quality health care, vol. 5, no. 4, pp. 180-188.
Frank, M. O. ; Batteiger, B. E. ; Sorensen, S. J. ; Hartstein, A. I. ; Carr, J. A. ; McComb, J. S. ; Clark, C. D. ; Abel, S. R. ; Mikuta, J. M. ; Jones, R. B. / Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. In: Clinical performance and quality health care. 1997 ; Vol. 5, No. 4. pp. 180-188.
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AU - Frank, M. O.

AU - Batteiger, B. E.

AU - Sorensen, S. J.

AU - Hartstein, A. I.

AU - Carr, J. A.

AU - McComb, J. S.

AU - Clark, C. D.

AU - Abel, S. R.

AU - Mikuta, J. M.

AU - Jones, R. B.

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N2 - OBJECTIVE: To evaluate changes in antimicrobial use and expenditures and the rates of selected nosocomial infections due to resistant organisms associated with implementation of an antimicrobial-prescribing improvement program. DESIGN: Before-after trial comparing 1992 (pre-program), 1993 (a transition year), and 1994 (after full implementation of the program). SETTING AND PARTICIPANTS: Academic medical center, all patients and physicians. INTERVENTION: An antimicrobial-prescribing improvement program with prior approval requirement for use of restricted agents. MAIN OUTCOME MEASURES: Antimicrobial use and expenditures, rates of selected nosocomial infection marker events. RESULTS: Between 1992 and 1994, there were substantial decreases in antimicrobial use, from 158,107 to 137,364 defined daily doses, and in expenditures from $2,486,902 ($24.01 per patient day) to $1,701,522 ($18.49 per patient day). After adjusting for changes in purchase prices and census days, we estimated savings attributable to the program of $279,573 in 1993 and $389,814 in 1994. In addition, we found significant decreases between 1992 and 1994 in the rates of enterococcal bacteremia (.34 vs .16 events per 1,000 patient days; P = .016), selected gram-negative bacteremia (.26 vs .11; P = .015), methicillin-resistant Staphylococcus aureus colonization or infection (.66 vs .20; P < .0001), and Stenotrophomonas colonization or infection (.35 vs .17; P = .019). No significant change occurred in rates of nosocomial candidemia or Clostridium difficile toxin-positive diarrhea. Values for 1993 were intermediate between those of 1992 and 1994. CONCLUSION: Implementation of an antimicrobial-prescribing improvement program was associated with substantial savings in antimicrobial use and expenditures and significant decreases in rates of selected nosocomial infections due to resistant organisms.

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