Impact of an antibiotic restriction program on antibiotic utilization in the treatment of community-acquired pneumonia in a Veterans Affairs Medical Center.

ABSTRACT

PURPOSE: The impact of an antibiotic restriction program (ARP) on the patterns of antibiotic use in the treatment of community-acquired pneumonia (CAP) was examined. We also evaluated the association between the ARP and the length of hospital stay in regard to CAP treatment and cost savings associated with the implementation of the ARP. METHODS: A retrospective cohort study of patients admitted with CAP was conducted during two 6-month periods, one prior to the ARP and one after the ARP. The health system's computerized patient record system (CPRS) was used to obtain demographics, length of hospital stays, readmission rates, blood culture results, co-morbidities, antibiotic use, and durations of therapy. A total of 130 patients met the inclusion criteria for the final analyses. Average drug costs, employee salaries, and the cost of laboratory procedures were used to assess cost savings associated with the ARP. RESULTS: From a total of 132 antibiotics that were ordered to treat CAP in the pre-ARP period, 28 were restricted (21.2%). However, the number of restricted antibiotics ordered was significantly reduced to 12 out of 114 (10.2%) antibiotics ordered in the post-ARP period (P = 0.024). In post-ARP implementation, the mean length of hospital stay was also significantly reduced from 7.6 to 5.8 days (P = 0.017), and although not statistically significant, the 30-day readmission rates declined from 16.9 to 6.2% (P = 0.097). The ARP was also associated with a saving of $943 per patient treated for CAP. CONCLUSIONS: In addition to a decrease in the antibiotic utilization and the mean length of hospital stay, the ARP may have yielded cost savings and reduced the readmission rates for those patients admitted and treated for CAP.