Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Antimicrobial Resistance & Infection Control
Published in: Antimicrobial Resistance & Infection Control 1/2019

Open Access 01-12-2019 | Antibiotic | Review

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Authors: Dilip Nathwani, Della Varghese, Jennifer Stephens, Wajeeha Ansari, Stephan Martin, Claudie Charbonneau

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2019

Login to get access

Abstract

Background

Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs.

Methods

An update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs.

Results

One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range: $2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions.

Conclusions

Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention.
Literature
1.
O’Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Rev Antimicrob Resist. 2014;20:1–16.
2.
3.
4.
NICE. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. United Kingdom: National Institute for Health and Care Excellence; 2015.
5.
CDC. Get smart for healthcare. Checklist for Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta: Centers for Disease Control and Prevention; 2013.
6.
Dik J-WH, Vemer P, Friedrich AW, Hendrix R, Lo-Ten-Foe JR, Sinha B, et al. Financial evaluations of antibiotic stewardship programs—a systematic review. Front Microbiol. 2015;6:317.PubMedPubMedCentral
7.
Perez KK, Olsen RJ, Musick WL, Cernoch PL, Davis JR, Peterson LE, et al. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant gram-negative bacteremia. J Infect. 2014;69(3):216–25.CrossRefPubMed
8.
Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, et al. A world wide web–based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008;47(6):747–53.CrossRefPubMed
9.
Ansari F, Gray K, Nathwani D, Phillips G, Ogston S, Ramsay C, et al. Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother. 2003;52(5):842–8.CrossRefPubMed
10.
Apisarnthanarak A, Danchaivijitr S, Khawcharoenporn T, Limsrivilai J, Warachan B, Bailey TC, et al. Effectiveness of education and an antibiotic-control program in a tertiary care hospital in Thailand. Clin Infect Dis. 2006;42(6):768–75.CrossRefPubMed
11.
Bantar C, Sartori B, Vesco E, Heft C, Saúl M, Salamone F, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis. 2003;37(2):180–6.CrossRefPubMed
12.
Bartlett JM, Siola PL. Implementation and first-year results of an antimicrobial stewardship program at a community hospital. Am J Health-Syst Pharm. 2014;71(11):943–9.CrossRefPubMed
13.
Bevilacqua S, Demoré B, Boschetti E, Doco-Lecompte T, May I, May T, et al. 15 years of antibiotic stewardship policy in the Nancy teaching hospital. Med Mal Infect. 2011;41(10):532–9.CrossRefPubMed
14.
Borde JP, Kaier K, Steib-Bauert M, Vach W, Geibel-Zehender A, Busch H, et al. Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center. BMC Infect Dis. 2014;14(1):201.CrossRefPubMedPubMedCentral
15.
Boyles TH, Whitelaw A, Bamford C, Moodley M, Bonorchis K, Morris V, et al. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates. PLoS One. 2013;8(12):e79747.CrossRefPubMedPubMedCentral
16.
Bozkurt F, Kaya S, Gulsun S, Tekin R, Deveci Ö, Dayan S, et al. Assessment of perioperative antimicrobial prophylaxis using ATC/DDD methodology. Int J Infect Dis. 2013;17(12):e1212–e7.CrossRefPubMed
17.
Bruno-Murtha LA, Brusch J, Bor D, Li W, Zucker D. A pilot study of antibiotic cycling in the community hospital setting. Infect Control Hosp Epidemiol. 2005;26(1):81–7.CrossRefPubMed
18.
Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003;24(9):699–706.CrossRefPubMed
19.
Cheng V, To K, Li I, Tang B, Chan J, Kwan S, et al. Antimicrobial stewardship program directed at broad-spectrum intravenous antibiotics prescription in a tertiary hospital. Eur J Clin Microbiol Infect Dis. 2009;28(12):1447.CrossRefPubMed
20.
Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174(1):84–93.CrossRefPubMed
21.
Cook PP, Catrou PG, Christie JD, Young PD, Polk RE. Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram. J Antimicrob Chemother. 2004;53(5):853–9.CrossRefPubMed
22.
Danaher PJ, Milazzo NA, Kerr KJ, Lagasse CA, Lane JW. The antibiotic support team--a successful educational approach to antibiotic stewardship. Mil Med. 2009;174(2):201.CrossRefPubMed
23.
Del Arco A, Tortajada B, de la Torre J, Olalla J, Prada J, Fernández F, et al. The impact of an antimicrobial stewardship programme on the use of antimicrobials and the evolution of drug resistance. Eur J Clin Microbiol Infect Dis. 2015;34(2):247–51.CrossRefPubMed
24.
Dunn K, O’Reilly A, Silke B, Rogers T, Bergin C. Implementing a pharmacist-led sequential antimicrobial therapy strategy: a controlled before-and-after study. Int J Clin Pharm. 2011;33(2):208–14.CrossRefPubMed
25.
Forrest GN, Mehta S, Weekes E, Lincalis DP, Johnson JK, Venezia RA. Impact of rapid in situ hybridization testing on coagulase-negative staphylococci positive blood cultures. J Antimicrob Chemother. 2006;58(1):154–8.CrossRefPubMed
26.
Hagert BL, Williams C, Wieser CM, Rohrich MA, Lo TS, Newman WP, et al. Implementation and outcome assessment of an inpatient antimicrobial stewardship program. Hosp Pharm. 2012;47(12):939–45.CrossRef
27.
Katsios CM, Burry L, Nelson S, Jivraj T, Lapinsky SE, Wax RS, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Crit Care. 2012;16(6):R216.CrossRefPubMedPubMedCentral
28.
Krivoy N, Abed El-Ahal W, Bar-Lavie Y, Haddad S. Antibiotic prescription and cost patterns in a general intensive care unit. Pharm Pract (Granada). 2007;5(2):67–73.CrossRef
29.
Kullar R, Davis SL, Kaye KS, Levine DP, Pogue JM, Rybak MJ. Implementation of an antimicrobial stewardship pathway with Daptomycin for optimal treatment of methicillin-resistant Staphylococcus aureus bacteremia. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2013;33(1):3–10.CrossRef
30.
Leung V, Gill S, Sauve J, Walker K, Stumpo C, Powis J. Growing a “positive culture” of antimicrobial stewardship in a community hospital. Can J Hosp Pharm. 2011;64(5):314.PubMedPubMedCentral
31.
Lin Y-S, Lin I-F, Yen Y-F, Lin P-C, Shiu Y-c HH-Y, et al. Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan. Am J Infect Control. 2013;41(11):1069–72.CrossRefPubMed
32.
Lutters M, Harbarth S, Janssens JP, Freudiger H, Herrmann F, Michel JP, et al. Effect of a comprehensive, multidisciplinary, educational program on the use of antibiotics in a geriatric university hospital. J Am Geriatr Soc. 2004;52(1):112–6.CrossRefPubMed
33.
Mach R, Vlcek J, Prusova M, Batka P, Rysavy V, Kubena A. Impact of a multidisciplinary approach on antibiotic consumption, cost and microbial resistance in a Czech hospital. Pharm World Sci. 2007;29(5):565–72.CrossRefPubMed
34.
Magedanz L, Silliprandi EM, Dos Santos RP. Impact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: a quasi-experimental study. Int J Clin Pharm. 2012;34(2):290–4.CrossRefPubMed
35.
Malani AN, Richards PG, Kapila S, Otto MH, Czerwinski J, Singal B. Clinical and economic outcomes from a community hospital's antimicrobial stewardship program. Am J Infect Control. 2013;41(2):145–8.CrossRefPubMed
36.
Martínez MJ, Freire A, Rodriguez I, Bardán B, Castro I, Inaraja MT, et al. Clinical and economic impact of a pharmacist-intervention to promote sequential intravenous to oral clindamycin conversion. Pharm World Sci. 2000;22(2):53–8.CrossRefPubMed
37.
McLaughlin C, Bodasing N, Boyter A, Fenelon C, Fox J, Seaton R. Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study. QJM. 2005;98(10):745–52.CrossRefPubMed
38.
Mertz D, Koller M, Haller P, Lampert ML, Plagge H, Hug B, et al. Outcomes of early switching from intravenous to oral antibiotics on medical wards. J Antimicrob Chemother. 2009;64(1):188–99.CrossRefPubMedPubMedCentral
39.
Michaels K, Mahdavi M, Krug A, Kuper K. Implementation of an antimicrobial stewardship program in a community hospital: results of a three-year analysis. Hosp Pharm. 2012;47(8):608–16.CrossRef
40.
Miyawaki K, Miwa Y, Tomono K, Kurokawa N. The impact of antimicrobial stewardship by infection control team in a Japanese teaching hospital. Yakugaku Zasshi. 2010;130(8):1105–11.CrossRefPubMed
41.
Mondain V, Lieutier F, Hasseine L, Gari-Toussaint M, Poiree M, Lions C, et al. A 6-year antifungal stewardship programme in a teaching hospital. Infection. 2013;41(3):621–8.CrossRefPubMed
42.
Ng C, Wu T, Chan W, Leung Y, Li C, Tsang D, et al. Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong. Qual Saf Health Care. 2008;17(5):387–92.CrossRefPubMed
43.
Niwa T, Shinoda Y, Suzuki A, Ohmori T, Yasuda M, Ohta H, et al. Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital. Int J Clin Pract. 2012;66(10):999–1008.CrossRefPubMedPubMedCentral
44.
Nowak MA, Nelson RE, Breidenbach JL, Thompson PA, Carson PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health-Syst Pharm. 2012;69(17):1500–8.CrossRefPubMed
45.
Palmay L, Elligsen M, Walker SA, Pinto R, Walker S, Einarson T, et al. Hospital-wide rollout of antimicrobial stewardship: a stepped-wedge randomized trial. Clin Infect Dis. 2014;59(6):867–74.CrossRefPubMed
46.
Pate PG, Storey DF, Baum DL. Implementation of an antimicrobial stewardship program at a 60-bed long-term acute care hospital. Infect Control Hosp Epidemiol. 2012;33(4):405–8.CrossRefPubMed
47.
Rimawi RH, Mazer MA, Siraj DS, Gooch M, Cook PP. Impact of regular collaboration between infectious diseases and critical care practitioners on antimicrobial utilization and patient outcome. Crit Care Med. 2013;41(9):2099–107.CrossRefPubMed
48.
Rüttimann S, Keck B, Hartmeier C, Maetzel A, Bucher HC. Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clin Infect Dis. 2004;38(3):348–56.CrossRefPubMed
49.
Schwartzberg E, Rubinovich S, Hassin D, Haspel J, Ben-Moshe A, Oren M, et al. Developing and implementing a model for changing physicians’ prescribing habits–the role of clinical pharmacy in leading the change. J Clin Pharm Ther. 2006;31(2):179–85.CrossRefPubMed
50.
Seah XFV, Ong YLR, Tan SW, Krishnaswamy G, Chong CY, Tan NWH, et al. Impact of an antimicrobial stewardship program on the use of carbapenems in a tertiary women's and children's hospital, Singapore. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2014;34(11):1141–50.CrossRef
51.
Solomon DH, Van Houten L, Glynn RJ, Baden L, Curtis K, Schrager H, et al. Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Arch Intern Med. 2001;161(15):1897–902.CrossRefPubMed
52.
Standiford HC, Chan S, Tripoli M, Weekes E, Forrest GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol. 2012;33(4):338–45.CrossRefPubMed
53.
Storey DF, Pate PG, Nguyen AT, Chang F. Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital. Antimicrob Resist Infect Control. 2012;1(1):32.CrossRefPubMedPubMedCentral
54.
Teo J, Kwa A, Loh J, Chlebicki M, Lee W. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital. Eur J Clin Microbiol Infect Dis. 2012;31(6):947–55.CrossRefPubMed
55.
Tsang J, Tsang O, Yao R, Lai S. The Antimicrobal Stewardship Programme: where have we been... where are we going? World Hosp Health Serv: the official journal of the International Hospital Federation. 2013;49(2):18–21.
56.
Yen Y-H, Chen H-Y, Wuan-Jin L, Lin Y-M, Shen WC, Cheng K-J. Clinical and economic impact of a pharmacist-managed iv-to-po conversion service for levofloxacin in Taiwan. Int J Clin Pharmacol Ther. 2012;50(2):136–41.CrossRefPubMed
57.
Yu K, Rho J, Morcos M, Nomura J, Kaplan D, Sakamoto K, et al. Evaluation of dedicated infectious diseases pharmacists on antimicrobial stewardship teams. Am J Health-Syst Pharm. 2014;71(12):1019–28.CrossRefPubMed
58.
Zhang H-X, Li X, Huo H-Q, Liang P, Zhang J-P, Ge W-H. Pharmacist interventions for prophylactic antibiotic use in urological inpatients undergoing clean or clean-contaminated operations in a Chinese hospital. PLoS One. 2014;9(2):e88971.CrossRefPubMedPubMedCentral
59.
Alawi MM, Darwesh BM. A stepwise introduction of a successful antimicrobial stewardship program: experience from a tertiary care university hospital in Western, Saudi Arabia. Saudi Med J. 2016;37(12):1341–9.CrossRef
60.
Borde JP, Nussbaum S, Hauser S, Hehn P, Hübner J, Sitaru G, et al. Implementing an intensified antibiotic stewardship programme targeting daptomycin use in orthopaedic surgery: a cost-benefit analysis from the hospital perspective. Infection. 2016;44(3):301–7.CrossRefPubMed
61.
Brink AJ, Messina AP, Feldman C, Richards GA, Becker PJ, Goff DA, et al. Antimicrobial stewardship across 47 South African hospitals: an implementation study. Lancet Infect Dis. 2016;16(9):1017–25.CrossRefPubMed
62.
Bunsow E, González-Del Vecchio M, Sanchez C, Muñoz P, Burillo A, Bouza E. Improved Sepsis Alert With a Telephone Call From the Clinical Microbiology Laboratory: A Clinical Trial. Medicine. 2015;94(39):e1454.CrossRefPubMedPubMedCentral
63.
Cai T, Verze P, Brugnolli A, Tiscione D, Luciani LG, Eccher C, et al. Adherence to European Association of Urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol. 2016;69(2):276–83.CrossRefPubMed
64.
Day SR, Smith D, Harris K, Cox HL, Mathers AJ. An Infectious diseases physician-led antimicrobial stewardship program at a small community hospital associated with improved susceptibility patterns and cost-savings after the first year. Open Forum Infectious Diseases. 2015;2(2):ofv064.CrossRefPubMedPubMedCentral
65.
Shridhar DP, Anitha K, Rai M, Fernandes A. Reserve drug indent form and its impact on antimicrobial consumption and sensitivity pattern in the medical intensive care unit of a tertiary care hospital. J Clin Diagn Res. 2015;9(2):FC05.PubMedPubMedCentral
66.
Estep PM, Ferreira JA, Dupree LH, Aldridge PJ, Jankowski CA. Impact of an antimicrobial stewardship initiative to evaluate β-lactam allergy in patients ordered aztreonam. Am J Health-Syst Pharm : AJHP : official journal of the American Society of Health-System Pharmacists. 2016;73(5 Suppl 1):S8–13.CrossRef
67.
Ferrat E, Le Breton J, Guéry E, Adeline F, Audureau E, Montagne O, et al. Effects 4.5 years after an interactive GP educational seminar on antibiotic therapy for respiratory tract infections: a randomized controlled trial. Fam Pract. 2016;33(2):192–9.CrossRefPubMed
68.
Fürst J, Čižman M, Mrak J, Kos D, Campbell S, Coenen S, et al. The influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications. Expert Rev Anti-Infect Ther. 2015;13(2):279–89.CrossRefPubMed
69.
Hamilton KW, Gerber JS, Moehring R, Anderson DJ, Calderwood MS, Han JH, et al. Point-of-prescription interventions to improve antimicrobial stewardship. Clin Infect Dis. 2015;60(8):1252–8.CrossRefPubMedPubMedCentral
70.
Hohn A, Heising B, Hertel S, Baumgarten G, Hochreiter M, Schroeder S. Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis. Infection. 2015;43(4):405–12.CrossRefPubMed
71.
Hunter R. Cost-effectiveness of point-of-care C-reactive protein tests for respiratory tract infection in primary care in England. Adv Ther. 2015;32(1):69–85.CrossRefPubMedPubMedCentral
72.
Hurst AL, Child J, Pearce K, Palmer C, Todd JK, Parker SK. Handshake stewardship: a highly effective rounding-based antimicrobial optimization service. Pediatr Infect Dis J. 2016;35(10):1104–10.CrossRefPubMed
73.
Hussein AK, Ibrahim MM, Tammam TF, Sarhan HA, Gad GF. Impact on use of antimicrobial prescribing order form in ICU daily practice in adjustment of antimicrobial prescribing and in enhancement of patients clinical outcomes. Int J Pharm Bio Sci. 2017;8(2):P214–P20.CrossRef
74.
Lambert M-L, Bruyndonckx R, Goossens H, Hens N, Aerts M, Catry B, et al. The Belgian policy of funding antimicrobial stewardship in hospitals and trends of selected quality indicators for antimicrobial use, 1999-2010: a longitudinal study. BMJ Open. 2015;5(2):e006916.CrossRefPubMedPubMedCentral
75.
Lee KR, Bagga B, Arnold SR. Reduction of broad-Spectrum antimicrobial use in a tertiary Children’s hospital post antimicrobial stewardship program guideline implementation. Pediatr Crit Care Med : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2016;17(3):187–93.CrossRef
76.
Lee TC, Frenette C, Jayaraman D, Green L, Pilote L. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med. 2014;161(10 Suppl):S53–8.CrossRefPubMed
77.
Liew YX, Lee W, Kwa AL-H, Chlebicki MP. Cost effectiveness of an antimicrobial stewardship programme. Int J Antimicrob Agents. 2015;46(5):594–5.CrossRefPubMed
78.
MacVane SH, Nolte FS. Benefits of adding a rapid PCR-based blood culture identification panel to an established antimicrobial stewardship program. J Clin Microbiol. 2016;54(10):2455–63.CrossRefPubMedPubMedCentral
79.
Nilholm H, Holmstrand L, Ahl J, Månsson F, Odenholt I, Tham J, et al. An audit-based, infectious disease specialist-guided antimicrobial stewardship program profoundly reduced antibiotic use without negatively affecting patient outcomes. Open Forum Infect Dis. 2015;2(2):ofv042 Oxford University Press.CrossRefPubMedPubMedCentral
80.
Okumura LM, da Silva MMG, Veroneze I. Effects of a bundled antimicrobial stewardship program on mortality: a cohort study. Braz J Infect Dis. 2015;19(3):246–52.CrossRefPubMed
81.
Pardo J, Klinker KP, Borgert SJ, Butler BM, Giglio PG, Rand KH. Clinical and economic impact of antimicrobial stewardship interventions with the FilmArray blood culture identification panel. Diagn Microbiol Infect Dis. 2016;84(2):159–64.CrossRefPubMed
82.
Smith T, Philmon C, Johnson G, Ward W, Rivers L, Williamson S, et al. Original article: antimicrobial stewardship in a community hospital: attacking the more difficult problems. Hosp Pharm. 2014;49(9):839–46.CrossRefPubMedPubMedCentral
83.
Taggart LR, Leung E, Muller MP, Matukas LM, Daneman N. Differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units: a controlled interrupted time series study. BMC Infect Dis. 2015;15:480.CrossRefPubMedPubMedCentral
84.
Zhou L, Ma J, Gao J, Chen S, Bao J. Optimizing prophylactic antibiotic practice for cardiothoracic surgery by Pharmacists’ effects. Medicine. 2016;95(9):e2753.CrossRefPubMedPubMedCentral
85.
Matsuda S, Ogasawara T, Sugimoto S, Kato S, Umezawa H, Yano T, et al. Prospective open-label randomized comparative, non-inferiority study of two initial antibiotic strategies for patients with nursing-and healthcare-associated pneumonia: guideline-concordant therapy versus empiric therapy. J Infect Chemother. 2016;22(6):400–6.CrossRefPubMed
86.
Rutman L, Wright DR, O'Callaghan J, Spencer S, Lion KC, Kronman MP, et al. A comprehensive approach to pediatric pneumonia: relationship between standardization, antimicrobial stewardship, clinical testing, and cost. J Healthc Qual. 2017;39(4):e59–69.CrossRefPubMed
87.
Taniguchi T, Tsuha S, Shiiki S, Narita M. Gram-stain-based antimicrobial selection reduces cost and overuse compared with Japanese guidelines. BMC Infect Dis. 2015;15:458.CrossRefPubMedPubMedCentral
88.
Arnold FW, McDonald LC, Smith RS, Newman D, Ramirez JA. Improving antimicrobial use in the hospital setting by providing usage feedback to prescribing physicians. Infect Control Hosp Epidemiol. 2006;27(4):378–82.CrossRefPubMed
89.
Ding H, Yang Y, Wei J, Fan S, Yu S, Yao K, et al. Influencing the use of antibiotics in a Chinese pediatric intensive care unit. Pharm World Sci. 2008;30(6):787–93.CrossRefPubMed
90.
Philmon C, Smith T, Williamson S, Goodman E. Controlling use of antimicrobials in a community teaching hospital. Infect Control Hosp Epidemiol. 2006;27(3):239–44.CrossRefPubMed
91.
Al-Eidan FA, McElnay JC, Scott M, Kearney M, Corrigan J, McConnell J. Use of a treatment protocol in the management of community-acquired lower respiratory tract infection. J Antimicrob Chemother. 2000;45(3):387–94.CrossRefPubMed
92.
Barenfanger J, Drake C, Leon N, Mueller T, Troutt T. Clinical and financial benefits of rapid detection of respiratory viruses: an outcomes study. J Clin Microbiol. 2000;38(8):2824–8.PubMedPubMedCentral
93.
Bauer KA, West JE, Balada-Llasat J-M, Pancholi P, Stevenson KB, Goff DA. An antimicrobial stewardship program's impact. Clin Infect Dis. 2010;51(9):1074–80.CrossRefPubMed
94.
Frighetto L, Marra CA, Stiver HG, Bryce EA, Jewesson PJ. Economic impact of standardized orders for antimicrobial prophylaxis program. Ann Pharmacother. 2000;34(2):154–60.CrossRefPubMed
95.
Gentry CA, Greenfield RA, Slater LN, Wack M, Huycke MM. Outcomes of an antimicrobial control program in a teaching hospital. Am J Health Syst Pharm. 2000;57(3):268–74.CrossRefPubMed
96.
Heil EL, Daniels LM, Long DM, Rodino KG, Weber DJ, Miller MB. Impact of a rapid peptide nucleic acid fluorescence in situ hybridization assay on treatment of Candida infections. Am J Health Syst Pharm. 2012;69(21):1910–4.CrossRefPubMed
97.
Ho BP, Lau TT, Balen RM, Naumann TL, Jewesson PJ. The impact of a pharmacist-managed dosage form conversion service on ciprofloxacin usage at a major Canadian teaching hospital: a pre-and post-intervention study. BMC Health Serv Res. 2005;5(1):48.CrossRefPubMedPubMedCentral
98.
Maddox ML, DeBoer EC, Hammerquist RJ. Administration of Extended Infusion Piperacillin-TazobactamWith the use of smart pump technology. Hosp Pharm. 2014;49(5):444–8.CrossRefPubMedPubMedCentral
99.
McGregor JC, Weekes E, Forrest GN, Standiford HC, Perencevich EN, Furuno JP, et al. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc. 2006;13(4):378–84.CrossRefPubMedPubMedCentral
100.
Oosterheert JJ, Van Loon AM, Schuurman R, Hoepelman AI, Hak E, Thijsen S, et al. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis. 2005;41(10):1438–44.CrossRefPubMed
101.
Perez KK, Olsen RJ, Musick WL, Cernoch PL, Davis JR, Land GA, et al. Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med. 2012;137(9):1247–54.CrossRefPubMed
102.
Reed EE, West JE, Keating EA, Pancholi P, Balada-Llasat J-M, Mangino JE, et al. Improving the management of candidemia through antimicrobial stewardship interventions. Diagn Microbiol Infect Dis. 2014;78(2):157–61.CrossRefPubMed
103.
Wong JR, Bauer KA, Mangino JE, Goff DA. Antimicrobial stewardship pharmacist interventions for coagulase-negative staphylococci positive blood cultures using rapid polymerase chain reaction. Ann Pharmacother. 2012;46(11):1484–90.CrossRefPubMed
104.
Barber KE, Bell AM, Travis King S, Parham JJ, Stover KR. Impact of piperacillin-tazobactam shortage on meropenem use: implications for antimicrobial stewardship programs. Braz J Infect Dis : an official publication of the Brazilian Society of Infectious Diseases. 2016;20(6):631–4.CrossRef
105.
Cai Y, Shek PY, Teo I, Tang SSL, Lee W, Liew YX, et al. A multidisciplinary antimicrobial stewardship programme safely decreases the duration of broad-spectrum antibiotic prescription in Singaporean adult renal patients. Int J Antimicrob Agents. 2016;47(1):91–6.CrossRefPubMed
106.
Dik J-WH, Hendrix R, Friedrich AW, Luttjeboer J, Panday PN, Wilting KR, et al. Cost-minimization model of a multidisciplinary antibiotic stewardship team based on a successful implementation on a urology ward of an academic hospital. PLoS One. 2015;10(5):e0126106.CrossRefPubMedPubMedCentral
107.
Egger ME, Myers JA, Arnold FW, Pass LA, Ramirez JA, Brock GN. Cost effectiveness of adherence to IDSA/ATS guidelines in elderly patients hospitalized for community-Aquired pneumonia. BMC Med Inform Decis Mak. 2016;16:34.CrossRefPubMedPubMedCentral
108.
Fanning M, McKean M, Seymour K, Pillans P, Scott I. Adherence to guideline-based antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease in an Australian tertiary hospital. Intern Med J. 2014;44(9):903–10.CrossRefPubMed
109.
MacVane SH, Hurst JM, Boger MS, Gnann JW Jr. Impact of a rapid multiplex polymerase chain reaction blood culture identification technology on outcomes in patients with vancomycin-resistant Enterococcal bacteremia. Infect Dis. 2016;48(10):732–7.CrossRef
110.
Lockwood AM, Perez KK, Musick WL, Ikwuagwu JO, Attia E, Fasoranti OO, et al. Integrating rapid diagnostics and antimicrobial stewardship in two community hospitals improved process measures and antibiotic adjustment time. Infect Control Hosp Epidemiol. 2016;37(4):425–32.CrossRefPubMed
111.
Pasquale TR, Trienski TL, Olexia DE, Myers JP, Tan MJ, Leung AK, et al. Impact of an antimicrobial stewardship program on patients with acute bacterial skin and skin structure infections. Am J Health Syst Pharm. 2014;71(13):1136–9.CrossRefPubMed
112.
Patel TS, Kaakeh R, Nagel JL, Newton DW, Stevenson JG. Cost analysis of implementing matrix- assisted laser desorption ionization-time of flight mass spectrometry plus real-time antimicrobial stewardship intervention for bloodstream infections. J Clin Microbiol. 2017;55(1):60–7.CrossRefPubMed
113.
Wenzler E, Goff DA, Mangino JE, Reed EE, Wehr A, Bauer KA. Impact of rapid identification of Acinetobacter Baumannii via matrix-assisted laser desorption ionization time-of-flight mass spectrometry combined with antimicrobial stewardship in patients with pneumonia and/or bacteremia. Diagn Microbiol Infect Dis. 2016;84(1):63–8.CrossRefPubMed
114.
van Daalen FV, Opmeer BC, Prins JM, Geerlings SE, Hulscher MEL. The economic evaluation of an antibiotic checklist as antimicrobial stewardship intervention. J Antimicrob Chemother. 2017;72(11):3213–21.CrossRefPubMed
115.
Gibson S, Rofe O. Development of a Successful Business Case for Significant Expansion of an Antimicrobial Stewardship Program [poster]: Eastern Health. [Poster]. Melbourne: Department of Pharmacy, Eastern Health; 2015.
116.
Trupka T, Fisher K, Micek ST, Juang P, Kollef MH. Enhanced antimicrobial de-escalation for pneumonia in mechanically ventilated patients: a cross-over study. Crit Care. 2017;21(1):180.CrossRefPubMedPubMedCentral
117.
Zahar J-R, Rioux C, Girou E, Hulin A, Sauve C, Bernier-Combes A, et al. Inappropriate prescribing of aminoglycosides: risk factors and impact of an antibiotic control team. J Antimicrob Chemother. 2006;58(3):651–6.CrossRefPubMed
118.
Lanbeck P, Tennvall GR, Resman F. A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance. BMC Health Serv Res. 2016;16(1):311.CrossRefPubMedPubMedCentral
119.
Slayton RB, Scott RD, Baggs J, Lessa FC, McDonald LC, Jernigan JA. The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program. Infect Control Hosp Epidemiol. 2015;36(6):681–7.CrossRefPubMedPubMedCentral
120.
Fu RZ, Anwar DR, Laban JT, Maratos EC, Minhas PS, Martin AJ. Pre-emptive intrathecal vancomycin therapy reduces external ventricular drain infection: a single Centre retrospective case-control study. Br J Neurosurg. 2017;31(1):16–20.CrossRefPubMed
121.
Okumura LM, Riveros BS, Gomes-da-Silva MM, Veroneze I. A cost-effectiveness analysis of two different antimicrobial stewardship programs. Braz J Infect Dis : an official publication of the Brazilian Society of Infectious Diseases. 2016;20(3):255–61.CrossRef
122.
Sick AC, Lehmann CU, Tamma PD, Lee CK, Agwu AL. Sustained savings from a longitudinal cost analysis of an internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol. 2013;34(6):573–80.CrossRefPubMed
123.
Gross R, Morgan AS, Kinky DE, Weiner M, Gibson GA, Fishman NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis. 2001;33(3):289–95.CrossRefPubMed
124.
Benson JM. Incorporating pharmacy student activities into an antimicrobial stewardship program in a long-term acute care hospital. Am J Health-Syst Pharm. 2014;71(3):227–30.CrossRefPubMed
125.
Grant EM, Kuti JL, Nicolau DP, Nightingale C, Quintiliani R. Clinical efficacy and Pharmacoeconomics of a continuous-infusion piperacillin-Tazobactam program in a large community teaching hospital. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2002;22(4):471–83.CrossRef
126.
Hermsen ED, Shull SS, Puumala SE, Rupp ME. Improvement in prescribing habits and economic outcomes associated with the introduction of a standardized approach for surgical antimicrobial prophylaxis. Infect Control Hosp Epidemiol. 2008;29(5):457–61.CrossRefPubMed
127.
LaRocco A Jr. Concurrent antibiotic review programs—a role for infectious diseases specialists at small community hospitals. Clin Infect Dis. 2003;37(5):742–3.CrossRefPubMed
128.
López-Medrano F, San Juan R, Lizasoain M, Catalán M, Ferrari J, Chaves F, et al. A non-compulsory stewardship programme for the management of antifungals in a university-affiliated hospital. Clin Microbiol Infect. 2013;19(1):56–61.CrossRefPubMed
129.
Melo D, Cassettari V, Ribeiro E. Educational intervention program to optimize the use of antibiotics: impact on prescribing habits, consumption of antimicrobial agents and cost savings. Revista de Ciências Farmacêuticas Básica e Aplicada. 2009;29(3):251–6.
130.
Saizy-Callaert S, Causse R, Furhman C, Le Paih M, Thébault A, Chouaıd C. Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital. J Hosp Infect. 2003;53(3):177–82.CrossRefPubMed
131.
South M, Royle J, Starr M. A simple intervention to improve hospital antibiotic prescribing. Med J Aust. 2003;178(5):207–9.PubMed
132.
Suryadevara M, Steidl KE, Probst LA, Shaw J. Inappropriate vancomycin therapeutic drug monitoring in hospitalized pediatric patients increases pediatric trauma and hospital costs. J Pediatr Pharmacol Ther. 2012;17(2):159–65.PubMedPubMedCentral
133.
Ullman MA, Parlier GL, Warren JB, Mateo N, Harvey C, Sullivan CJ, et al. The economic impact of starting, stopping, and restarting an antibiotic stewardship program: a 14-year experience. Antibiotics. 2013;2(2):256–64.CrossRefPubMedPubMedCentral
134.
Weeks C, Jones G, Wyllie S. Cost and health care benefits of an antimicrobial management programme. HOSPITAL PHARMACIST-LONDON. 2006;13(5):179.
135.
Yam P, Fales D, Jemison J, Gillum M, Bernstein M. Implementation of an antimicrobial stewardship program in a rural hospital. Am J Health Syst Pharm. 2012;69(13):1142.CrossRefPubMed
136.
Dela-Pena J, Kerstenetzky L, Schulz L, Kendall R, Lepak A, Fox B. Top 1% of inpatients administered antimicrobial agents comprising 50% of expenditures: a descriptive study and opportunities for stewardship intervention. Infect Control Hosp Epidemiol. 2017;38(3):259–65.CrossRefPubMed
137.
Franklin M, Wailoo A, Dayer MJ, Jones S, Prendergast B, Baddour LM, et al. The cost-effectiveness of antibiotic prophylaxis for patients at risk of infective endocarditis. Circulation. 2016;134(20):1568–78.CrossRefPubMedPubMedCentral
138.
Lemaire X, Robineau O, Blanc AL, Vialle B, Béguec J, Hendricx S, et al. Distribution of antimicrobial guidelines: useful but not enough for an antibiotic stewardship. Presse Med. 2014;43(11):e365–e8.CrossRefPubMed
139.
Aiken AM, Wanyoro AK, Mwangi J, Juma F, Mugoya IK, Scott JAG. Changing use of surgical antibiotic prophylaxis in Thika hospital, Kenya: a quality improvement intervention with an interrupted time series design. PLoS One. 2013;8(11):e78942.CrossRefPubMedPubMedCentral
140.
Apisarnthanarak A, Yatrasert A, Mundy LM. Impact of education and an antifungal stewardship program for candidiasis at a Thai tertiary care center. Infect Control Hosp Epidemiol. 2010;31(7):722–7.CrossRefPubMed
141.
Beardsley JR, Williamson JC, Johnson JW, Luther VP, Wrenn RH, Ohl CC. Show me the money: long-term financial impact of an antimicrobial stewardship program. Infect Control Hosp Epidemiol. 2012;33(4):398–400.CrossRefPubMed
142.
Calloway S, Akilo HA, Bierman K. Impact of a clinical decision support system on pharmacy clinical interventions, documentation efforts, and costs. Hosp Pharm. 2013;48(9):744–52.CrossRefPubMedPubMedCentral
143.
Hamblin S, Rumbaugh K, Miller R. Prevention of adverse drug events and cost savings associated with PharmD interventions in an academic level I trauma center: an evidence-based approach. J Trauma Acute Care Surg. 2012;73(6):1484–90.CrossRefPubMed
144.
Rimawi RH, Cook PP, Gooch M, Kabchi B, Ashraf MS, Rimawi BH, et al. The impact of penicillin skin testing on clinical practice and antimicrobial stewardship. J Hosp Med. 2013;8(6):341–5.CrossRefPubMed
145.
Sutherland T, Beloff J, Lightowler M, Liu X, Nascimben L, Kaye AD, et al. Description of a multidisciplinary initiative to improve SCIP measures related to pre-operative antibiotic prophylaxis compliance: A single-center success story. Patient Saf Surgery. 2014;8(1):37.CrossRef
146.
Saeed K, Dryden M, Bourne S, Paget C, Proud A. Reduction in antibiotic use through procalcitonin testing in patients in the medical admission unit or intensive care unit with suspicion of infection. J Hosp Infect. 2011;78(4):289–92.CrossRefPubMed
147.
148.
Catalá-López F, García-Altés A, Álvarez-Martín E, Gènova-Maleras R, Morant-Ginestar C, Parada A. Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters? BMC Health Serv Res. 2011;11:75.CrossRefPubMedPubMedCentral
149.
Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. The Cochrane Library. 2017.
150.
Karanika S, Paudel S, Grigoras C, Kalbasi A, Mylonakis E. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrob Agents Chemother. 2016;60(8):4840–52.CrossRefPubMedPubMedCentral
151.
Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17(9):990–1001.CrossRefPubMed
152.
Ibrahim OM, Polk RE. Benchmarking antimicrobial drug use in hospitals. Expert Rev Anti-Infect Ther. 2012;10(4):445–57.CrossRefPubMed
153.
Momattin H, Al-Ali AY, Mohammed K, Al-Tawfiq JA. Benchmarking of antibiotic usage: an adjustment to reflect antibiotic stewardship program outcome in a hospital in Saudi Arabia. J Infect Public Health. 2018;11(3):310–3.CrossRefPubMed
154.
Nathwani D, Eckmann C, Lawson W, Stephens J, Macahilig C, Solem C, et al. Pan-European early switch/early discharge opportunities exist for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections. Clin Microbiol Infect. 2014;20(10):993–1000.CrossRefPubMed
155.
Metadata
Title
Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review
Authors
Dilip Nathwani
Della Varghese
Jennifer Stephens
Wajeeha Ansari
Stephan Martin
Claudie Charbonneau
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Antibiotic
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2019
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-019-0471-0

Other articles of this Issue 1/2019

Antimicrobial Resistance & Infection Control 1/2019 Go to the issue

Research

Implementation of infection prevention and control in acute care hospitals in Mainland China – a systematic review

Research

Assessment of tolerability and acceptability of an alcohol-based hand rub according to a WHO protocol and using apparatus tests

Research

The species distribution, antimicrobial resistance and risk factors for poor outcome of coagulase-negative staphylococci bacteraemia in China

Research

Molecular characterization of class 1, 2 and 3 integrons in clinical multi-drug resistant Klebsiella pneumoniae isolates

Research

Point prevalence survey of peripheral venous catheter usage in a large tertiary care university hospital in Germany

Research

Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits