Impact of antimicrobial stewardship consultation service at an academic institution

Background Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use to decrease resistance and acquisition of hospital-acquired infections, improve patient outcomes, and reduce health care costs. We evaluated interventions and outcomes associated with a dedicated stewardship consult service staffed by physician assistant with supervision from infectious disease physician. Methods This was a retrospective study of electronic medical records of adult patients evaluated by the ASP team from November 2012 to December 2013 in an 802-bed teaching hospital in Detroit, Mich. Hospice patients were excluded. Patient characteristics, type of infection, microbiological cultures, antimicrobials utilized, interventions performed, and clinical outcomes were assessed. Results Three hundred thirty-five patients met the inclusion criteria. Median age was 67 years, and 52% were male. The most common infections were lower respiratory (28%) and urinary tract infections (21%). However, 24% were diagnosed as having no infection, and of these, 67% had asymptomatic bacteriuria. Escherichia coli (21%) and methicillin-resistant Staphylococcus aureus (14%) were most frequently isolated pathogens. The ASP team denied 38% of peripherally inserted central catheter requests and recommended intravenous-to-oral conversion in 38% cases, discontinuation of antibiotics in 27%, and de-escalation of therapy in 13%. Vancomycin (18%) and quinolones (16%) were the most commonly prescribed antibiotics. The majority of patients (95%) had clinical success, whereas very few developed Clostridium difficile infection (1.5%) or had infection-related readmission (2%) within 30 days. Conclusions Our ASP consult service reduced unnecessary peripherally inserted central catheter placement and antimicrobial use with favorable clinical success and patient outcomes. In light of the new regulatory ASP requirements, a midlevel provider may be beneficial to and an integral part of an infectious disease physician-supervised stewardship team