Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities: A Decision Analytic Model.
Clin J Am Soc Nephrol
; 13(9): 1389-1397, 2018 09 07.
Article
em En
| MEDLINE
| ID: mdl-30139804
ABSTRACT
BACKGROUND AND OBJECTIVES:
Infections caused by multidrug-resistant organisms and Clostridium difficile are associated with substantial morbidity and mortality as well as excess costs. Antimicrobial exposure is the leading cause for these infections. Approximately 30% of antimicrobial doses administered in outpatient hemodialysis facilities are considered unnecessary. Implementing an antimicrobial stewardship program in outpatient hemodialysis facilities aimed at improving prescribing practices would have important clinical and economic benefits. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The main outcomes were total antimicrobial use, infections caused by multidrug-resistant organisms and C. difficile, infection-related mortality, and total costs. The analysis considered all patients on outpatient hemodialysis in the United States. The value of implementing antimicrobial stewardship programs, assuming a 20% decrease in unnecessary antimicrobial doses, was calculated as the incremental differences in clinical end points and cost outcomes. Event probabilities, antimicrobial regimens, and health care costs were informed by publicly available sources.RESULTS:
On a national level, implementation of antimicrobial stewardship programs was predicted to result in 2182 fewer infections caused by multidrug-resistant organisms and C. difficile (4.8% reduction), 629 fewer infection-related deaths (4.6% reduction), and a cost savings of $106,893,517 (5.0% reduction) per year. The model was most sensitive to clinical parameters as opposed to antimicrobial costs.CONCLUSIONS:
The model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.Palavras-chave
Anti-Bacterial Agents; Anti-Infective Agents; Antimicrobial Stewardship; Clostridium Infections; Clostridium difficile; Cost Savings; Enterococcus; Health Care Costs; Outpatients; Probability; cefazolin; chronic hemodialysis; costs; infections; maintenance hemodialysis; mortality; multidrug-resistant organisms; renal dialysis; vancomycin
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Técnicas de Apoio para a Decisão
/
Diálise Renal
/
Custos de Cuidados de Saúde
/
Gestão de Antimicrobianos
/
Antibacterianos
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article