Effect of an antimicrobial stewardship programme on antimicrobial utilisation and costs in patients with leukaemia: a retrospective controlled study

To examine the effectiveness of an antimicrobial stewardship programme on utilization and cost of antimicrobials in leukaemia patients in Canada. We conducted a multisite retrospective observational time series study from 2005 to 2013. We implemented academic detailing as the intervention of an anti...

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Bibliographic Details
Published in:Clinical microbiology and infection 2018-08, Vol.24 (8), p.882-888
Main Authors: So, M., Mamdani, M.M., Morris, A.M., Lau, T.T.Y., Broady, R., Deotare, U., Grant, J., Kim, D., Schimmer, A.D., Schuh, A.C., Shajari, S., Steinberg, M., Bell, C.M., Husain, S.
Format: Article
Language:English
Subjects:
Antibiotic utilization
Antifungal utilization
Antimicrobial stewardship
Haematology-oncology
Quality of care
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Summary:To examine the effectiveness of an antimicrobial stewardship programme on utilization and cost of antimicrobials in leukaemia patients in Canada. We conducted a multisite retrospective observational time series study from 2005 to 2013. We implemented academic detailing as the intervention of an antimicrobial stewardship programme in leukaemia units at a hospital, piloted February–July 2010, then fully implemented December 2010–March 2013, with no intervention in August–November 2010. Internal control was the same hospital's allogeneic haematopoietic stem-cell transplantation unit. External control was the combined leukaemia–haematopoietic stem-cell transplantation unit at another hospital. Primary outcome was antimicrobial utilization (antibiotics and antifungals) in defined daily dose per 100 patient-days (PD). Secondary outcomes were antimicrobial cost (Canadian dollars per PD); cost and utilization by drug class; length of stay; 30-day inpatient mortality; and nosocomial Clostridium difficile infection. We used autoregressive integrated moving average models to evaluate the impact of the intervention on outcomes. The intervention group included 1006 patients before implementation and 335 during full implementation. Correspondingly, internal control had 723 and 264 patients, external control 1395 and 864 patients. Antimicrobial utilization decreased significantly in the intervention group (p 
ISSN:1198-743X
1469-0691
DOI:10.1016/j.cmi.2017.11.009