Development of Antibiotic Stewardship Practices Targeting Urinary Tract Infections in a Hospital With Consultant-Based Infectious Disease Services.

PURPOSE: Ensuring proper use of antimicrobials through the development and implementation of stewardship programs translates to improved patient outcomes. This article will describe the development of an antibiotic stewardship program at a facility with consultant-based infectious disease services. METHODS: Program development involved a multifaceted approach, including identification of a physician stewardship champion, design of a retrospective analysis, development of a physician scoring card, and creation and auditing of a real-time reporting system targeting prospective de-escalation opportunities. A seven-month retrospective chart analysis was performed on patients from two medical telemetry units with a diagnosis-related code for urinary tract infection to identify current prescribing practices of antimicrobials. The primary endpoint assessed the percentage of patients with missed opportunities for de-escalation. Secondary endpoints evaluated the impact on costs and hospital length of stay, comparing patients who were appropriately treated with those with missed de-escalation opportunities. RESULTS: Seventy-five patients were evaluated, 30 (40%) of whom were identified as having had missed opportunities for de-escalation. The cost of antibiotics for patients who were de-escalated averaged approximately $22.18 per day, compared with $70.26 per day (P = 0.04) for those with missed de-escalation opportunities. Patients receiving appropriate therapy had an average hospital length of stay of 6.42 days compared with 8.13 days for the missed-opportunity group (P = 0.052). CONCLUSION: The development of stewardship services at a consultant-based hospital is possible through a systematic approach, ultimately resulting in the expansion of available personnel and promotion of collaborative efforts.