Economic justification of antimicrobial management programs: Implications of antimicrobial resistance

The relationship between the problem of antimicrobial resistance and effort s to control antimicrobial costs is explored. Antimicrobial drug management typically centers around controlling costs an d controlling antimicrobial resistance. Selection of therapeutic alternativ es without adherence to a well-developed program or without a rationale bas ed on data from the medical literature may promote antimicrobial resistance . Attempts to select alternatives can produce cost shifting rather than cos t containment. The annual cost associated with antimicrobial resistance in the United States is estimated to be as high as $47 billion. In one study, patients with bacteremia caused by methicillin-resistant Staphylococcus aur eus had an average length of stay 2.7 days longer than patients with suscep tible strains and a mean cost of care that was $3500 higher. Infection cont rol is one of the most important duties of health care practitioners. Given today's prevailing reimbursement structure, hospitals with high rates of n osocomial and resistant infections are likely to lose money. A basic proble m with the current approach to controlling resistance is that the two most common strategies, highly restrictive formularies and drug cycling, work in opposition. Antimicrobial management programs should be directed at ensuring the most a ppropriate use of antimicrobials rather than focusing on limiting choices.