Rigorous antibiotic stewardship in the hospitalized elderly population: saving lives and decreasing cost of inpatient care

James Mauro; Saman Kannangara; Joanne Peterson; David Livert; Roman A Tuma

doi:10.1093/jacamr/dlab118

Rigorous antibiotic stewardship in the hospitalized elderly population: saving lives and decreasing cost of inpatient care

JAC Antimicrob Resist. 2021 Aug 12;3(3):dlab118. doi: 10.1093/jacamr/dlab118. eCollection 2021 Sep.

Authors

James Mauro¹, Saman Kannangara², Joanne Peterson³, David Livert^{4

5}, Roman A Tuma^{6

7}

Affiliations

¹ Department of Pharmacy, Easton Hospital, Easton, PA, USA.
² Department of Internal Medicine, Division of Infectious Diseases, Saint Francis Memorial Hospital, San Francisco, CA, USA.
³ Department of Infection Control, Hackensack Meridian, Bayshore Medical Center, Holmdel, NJ, USA.
⁴ Department of Medicine, Easton Hospital, Easton, PA, USA.
⁵ Penn State University, Center Valley, PA, USA.
⁶ Department of Internal Medicine, Hackensack Meridian, Bayshore Medical Center, Holmdel, NJ, USA.
⁷ Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA.

Abstract

Background: There is limited literature evaluating the effect of antibiotic stewardship programmes (ASPs) in hospitalized geriatric patients, who are at higher risk for readmissions, developing Clostridioides difficile infection (CDI) or other adverse outcomes secondary to antibiotic treatments.

Methods: In this cohort study we compare the rates of 30 day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. We also assessed their mortality rates and length of stay. Patients were included if they received antibiotics for pneumonia, urinary tract infection, acute bacterial skin and skin structure infection or complicated intra-abdominal infection. The ASP team reviewed patients on antibiotics daily. ASP interventions included de-escalation of empirical or definitive therapy, change in duration of therapy or discontinuation of therapy. Treatment failure was defined as readmission because of reinfection or a new infection. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analysed for comparison.

Results: We demonstrated that the 30 day hospital readmission rate for all infection types decreased during the ASP intervention period from 24.9% to 9.3%, P < 0.001. The rate of 30 day readmissions because of CDI decreased during the intervention period from 2.4% to 0.30%, P = 0.02. Mortality in the cohort that underwent ASP interventions decreased from 9.6% to 5.4%, P = 0.03. Lastly, antibiotic expenditure decreased after implementation of the ASP from $23.3 to $4.3 per adjusted patient day, in just 6 months.

Conclusions: Rigorous de-escalation and curtailing of antibiotic therapies were beneficial and without risk for the hospitalized patients 65 years and over.