Nationwide Antimicrobial Stewardship Programs in Outpatient Hemodialysis Facilities Would Save More Than 600 Lives per Year: Study

Implementing a coordinated program to improve antimicrobial use in outpatient kidney hemodialysis facilities nationwide would result in 629 fewer infection-related deaths per year among hemodialysis patients, a new AHRQ-funded study has projected. Approximately 30 percent of antimicrobial doses administered in these facilities are considered unnecessary, leading to increased multidrug-resistant organism and Clostridium difficile infections. Using data from multiple sources, the authors modeled outcomes to be expected by instituting antimicrobial stewardship programs that would improve antimicrobial prescribing through the use of guidelines and educational outreach. The study, published in the Clinical Journal of the American Society of Nephrology, predicts that, if implementing such programs led to a 20 percent decrease in unnecessary prescriptions, the result would be 2,182 fewer infections and savings of more than $100 million annually. Access the abstract.

2018 Aug 23. pii: CJN.12521117. doi: 10.2215/CJN.12521117. [Epub ahead of print]

Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities: A Decision Analytic Model.

D'Agata EMC1, Tran D2, Bautista J3, Shemin D4, Grima D2.

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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.

KEYWORDS:

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