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.