Providence makes gains in curbing antibiotic overuse

Steve Stoner, Pharm.D., BCPS
Regional director, Clinical Pharmacy Services

Oct. 16, 2013

More than half of hospitalized Americans are treated with antibiotics – and half are treated inappropriately. This overuse has contributed to increased morbidity and mortality rates, adverse drug reactions, the emergence of multidrug-resistant bacteria, a rise in health care-associated infections and increased hospital costs.

These developments prompted Providence to create Oregon Region Antimicrobial Stewardship Program, which was rolled out at all eight Oregon hospitals in 2012.

The program is a collaboration of infectious disease physicians, clinical pharmacists, a hospital epidemiologist, infection preventionists, information system analysts and hospital administrators. The program does a prospective review of antimicrobial therapy with appropriate intervention, restricts the antimicrobial agents on formulary, develops guideline and clinical pathways, provides streamlining or de-escalation of therapy, optimizes dosing, converts parenteral to oral therapy and does computer-based surveillance.

While we’re still gathering data across our ministries, early results show that Oregon compares favorably in its stewardship of broad-spectrum, high-cost antimicrobials used for pneumonia, sepsis and skin/soft tissue. These agents include daptomycin, doripenem, ertapenem, imipenem, linezolid, meropenem and piperacillin/tazobactum.

See table.

Oregon’s antimicrobial stewardship program is based on a successful model that Providence St. Vincent Medical Center launched in 1998. The hospital reported a lower rate of C. difficile than comparable facilities and the lowest rate of antibiotic purchases.

Providence’s Pharmacy Resource Council approved this initiative to develop antimicrobial stewardship programs throughout Providence’s system in 2011-2012. Oregon’s pharmacy department developed the current program in conjunction with the Oregon Region Infectious Disease Council.