Outcomes of an antimicrobial control program in a teaching hospital

The clinical outcomes and cost-effectiveness of an antimicrobial control pr ogram (ACP) were studied. The impact of an ACP in a teaching hospital was a nalyzed by comparing clinical outcomes and intravenous antimicrobial costs over two two-year periods, the two years before the program and the first t wo years after the program's inception. Admission baseline data, length of stay, mortality, and readmission rates were gathered for each patient. Pati ents were identified by using the international Classification of Diseases Multivariate logistic regression models were constructed for mortality and for lengths of stay of 12 or more days. The acquisition costs of intravenou s antimicrobial agents for the second baseline year and the entire program period were tabulated and compared. The average daily inpatient census was determined. The ACP was associated with a 2.4-day decrease in Length of stay and a redu ction in mortality from 8.28% to 6.61%. Rates of readmission for infection within 30 days of discharge remained about the same. Inpatient pharmacy cos ts other than intravenous antimicrobials decreased an average of only 5.7% over the two program years, but the acquisition cost of intravenous antimic robial for both program years yielded a total cost saving of $291,885, a re duction of 30.8%. The institution's average daily census fell 19% between t he second baseline year and the second program year. An ACP directed by a clinical pharmacist trained in infectious diseases was associated with improvements in inpatient length of stay and mortality. Th e ACP decreased intravenous antimicrobial costs and facilitated the approva l process for restricted and nonformulary antimicrobial agents.