Literature is limited in regard to evaluating antimicrobial stewardship program (ASP) outcomes in patients aged ≥65 years. Researchers performed a retrospective chart review of 461 patients (150 control and 311 intervention) to compare the rates of 30-day readmissions of patients aged ≥65 years who received ASP interventions with a control sample who received antibiotics pre-ASP.
Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI), and complicated intra-abdominal infection (cIAI). Interventions consisted of de-escalation of empiric or definitive therapy, change in duration of therapy, or discontinuation of therapy. Treatment failure was defined as readmission due to reinfection or development of a new infection (eg, Clostridium difficile).
The 30-day readmission rate for all infections decreased during the intervention period (10.7% vs 3.9%; P = .004). There was a statistically significant decrease in 30-day readmissions in the PNA subgroup (9.8% vs 2.9%; P = .038), a marginally significant decrease among patients with UTI (12.5% vs 4.7%; P = .097), and no statistically significant change in the ABSSSI (5.6% vs 8.6%; P = .694) and cIAI (20.8% vs 6.7%; P = .233) subgroups. The total adjusted patient-days (APDs) were 16,267 (control) and 15,487 (intervention). Total antimicrobial expenditure during the control period was $379,643 ($23.33/APD) versus $67,721 ($4.37/APD) during the intervention period.
ASP efforts did not lead to an increased rate of 30-day readmissions due to treatment failure. Furthermore, there was a statistically significant decrease in readmission rates in the intervention group, as well as a large decrease in antimicrobial expenditure per APD.
Source: Mauro J, et al. IDWeek 2018. Abstract 246.