Association of inpatient antimicrobial utilization measures with antimicrobial stewardship activities and facility characteristics of Veterans Affairs medical centers

Journal of Hospital Medicine 12(5). 2017 May;301-309 | 10.12788/jhm.2730

April 28, 2017|Journal of Hospital Medicine

Christopher J. Graber, MD, MPH;Makoto M. Jones, MD, MSc;Ann F. Chou, PhD;Yue Zhang, PhD;Matthew Bidwell Goetz, MD;Karl Madaras-Kelly, PharmD, MPH;Matthew H. Samore, MD;Peter A. Glassman, MBBS, MSc

Background

Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable.

Objective

To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012.

Design

In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals. From the survey, we identified 34 variables across 3 domains (evidence, organizational context, and facilitation) that were assessed using multivariable least absolute shrinkage and selection operator regression against 4 antimicrobial utilization measures from 2012: aggregate acute care antimicrobial use, antimicrobial use in patients with non-infectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and double anaerobic coverage.

Setting

All 130 VA facilities with acute care services.

Results

Variables associated with at least 3 favorable changes in antimicrobial utilization included presence of postgraduate physician/pharmacy training programs, number of antimicrobial-specific order sets, frequency of systematic de-escalation review, presence of pharmacists and/or infectious diseases (ID) attendings on acute care ward teams, and formal ID training of the lead ASP pharmacist. Variables associated with 2 unfavorable measures included bed size, the level of engagement with VA Antimicrobial Stewardship Task Force online resources, and utilization of antimicrobial stop orders.

Conclusions

Formalization of ASP processes and presence of pharmacy and ID expertise are associated with favorable utilization. Systematic de-escalation review and order set establishment may be high-yield interventions. Journal of Hospital Medicine 2017;12:301-309. © 2017 Society of Hospital Medicine

Acknowledgments

The authors wish to thank Michael Fletcher, Jaime Lopez, and Catherine Loc-Carrillo for their administrative and organizational support of the project and Allison Kelly, MD, for her pivotal role in survey development and distribution. This work was supported by the VA Health Services Research and Development Service Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) Initiative; Cognitive Support Informatics for Antimicrobial Stewardship project (CRE 12-313).