Antimicrobial Stewardship: Longitudinal Outcomes of Performance Improvement

The CDC estimates that a significant portion of antibiotic use in the US, ranging from 20% to 50%, is inappropriate or unnecessary, leading to various problems such as adverse drug events, superinfections, and the development of multi-drug resistant organisms. If not addressed, antimicrobial resistance could cause 10 million deaths annually by 2050, with a massive economic cost. In response to this, the Joint Commission required health systems to establish antimicrobial stewardship programs (AMS) to combat resistance and improve patient outcomes. The AMS program at St. Luke's University Health Network has been successful in reducing inappropriate antibiotic use by almost 22%, with interventions leading to substantial cost savings and a significant reduction in Clostridium difficile infection rates.

The implementation of the AMS program required a comprehensive approach, involving community support and education. The program's structure, based on prospective review, collaboration between Infectious Disease Providers and Pharmacists, and adherence to guidelines, aligned with the educational culture of the network and prioritized sustainability over strict medication access restrictions. Data analysis was crucial, even though initial data was limited, with metrics like Days of Therapy per 1,000 patient days (DOT) providing valuable insights into antibiotic utilization trends. The AMS program at St. Luke's has achieved a high success rate, intervening in thousands of cases, resulting in significant cost savings and a notable reduction in Clostridium difficile infection rates since its inception.