Economic impact of a rational use of antibiotics in intensive care

Objective: To evaluate the economic impact of a rational policy in antibiot ic treatment. Design: Comparative study with a retrospective and a prospective part. Setting: An 11-bed intensive care unit (ICU) in a general hospital. Patients: All patients admitted to the unit in 1994, 1995 and 1996. Interventions: In 1995, a program of cost control was started and a contrac t of agreed objectives signed with the director of the hospital. This contr act included a commitment to refund the eventual savings in order to improv e the quality of care. Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy. Measurements and results: The cost of antibiotic therapy, the patients' cha racteristics and the incidence of nosocomial infection were compared prior to and during the program. The expenses for antibiotic drugs decreased by 1 9 % in 1995 and by 22 % in 1996. Most of the savings were refunded to the I CU and contributed to the employment of an additional nurse and the purchas e of new material. In number of patients, type of disease, mean age, Simpli fied Acute Physiology Score, occupancy rate, length of stay, omega score, a rtificial ventilation, readmission within 7 days, mortality and incidence o f nosocomial infection, no significant difference was found. Conclusions: We proved a positive economic impact of a rational policy in a ntibiotic therapy realized with a contract of agreed objectives. The saving s made while applying our program of cost control were used to improve the quality of care.