5 years ago

Effect of an Antimicrobial Stewardship Programme on Antimicrobial Utilisation and Costs in Patients with Leukaemia: A Retrospective Interventional Controlled Study

To examine the effectiveness of an antimicrobial stewardship programme (ASPs) on utilisation and cost of antimicrobials in leukaemia patients in Canada. Methods We conducted a multisite, retrospective, observational time-series study from 2005 to 2013. We implemented academic detailing as the intervention of an ASP in leukaemia units at a hospital, piloted February-July 2010, then fully implemented December 2010-March 2013, with no intervention in August-November 2010. Internal control was the same hospital’s allogeneic haematopoietic stem cell transplant (HSCT) unit. External control was the combined leukaemia-HSCT unit at another hospital. Primary outcome was antimicrobial utilisation (antibiotics and antifungals) in defined daily dose/100 patient-days. Secondary outcomes were antimicrobial cost ($CAD/patient-day); cost and utilisation by drug class; length of stay; 30-day inpatient mortality; and nosocomial C. difficile infection. We used autoregressive integrated moving average (ARIMA) models to evaluate the impact of the intervention on outcomes. Results The intervention group included 1006 patients pre-implementation; 335 during full-implementation. Correspondingly, internal control had 723 and 264 patients; external control 1395 and 864 patients. Antimicrobial utilisation decreased significantly in intervention group (p<0.01, 278 vs. 247 DDD/100PD), increased in external control (p=0.01, 237.4 vs. 268.9 DDD/100PD), and remained stable in internal control (p=0.27). Antimicrobial cost decreased in intervention group (p=0.03; $154.59/PD vs. $128.93/PD), increased in external control (p=0.01; $109.4/PD vs. $135.97/PD), but was stable in internal control (p=0.27) Mortality, length of stay and nosocomial C. difficile rate in intervention group remained stable. Conclusion ASP reduced antimicrobial use in leukaemia patients without affecting inpatient mortality and length of stay.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17306390

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