Economic Impact of Redundant Antimicrobial Therapy
Economic Impact of Redundant Antimicrobial Therapy
Background. Overutilization of antimicrobial therapy places patients at risk for harm and contributes to antimicrobial resistance and escalating healthcare costs. Focusing on redundant or duplicate antimicrobial therapy is 1 recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs.
Objective. This study explored the incidence and economic impact of potentially redundant antimicrobial therapy.
Methods. We conducted a retrospective analysis of inpatient administrative data drawn from 505 nonfederal US hospitals. All hospitalized patients discharged between January 1, 2008, and December 31, 2011, were eligible for study inclusion. Potentially redundant antimicrobial therapy was identified from pharmacy records and was defined as patients receiving treatment with overlapping antibiotic spectra for 2 or more consecutive days.
Results. We found evidence of potentially inappropriate, redundant antimicrobial coverage for 23 different antimicrobial combinations in 394 of the 505 (78%) hospitals, representing a total of 32,507 cases. High-frequency redundancies were observed in 3 antianaerobic regimens, accounting for 22,701 (70%) of the cases. Of these, metronidazole and piperacillin-tazobactam accounted for 53% (n = 17,326) of all potentially redundant cases. Days of redundant therapy totaled 148,589, representing greater than $12 million in potentially avoidable healthcare costs.
Conclusions. Our study suggests that there may be pervasive use of redundant antimicrobial therapy within US hospitals. Appropriate use of antimicrobials may reduce the risk of harm to patients and lower healthcare costs.
Overuse and inappropriate use of antimicrobials is a major public health issue and contributes to patient harm, antimicrobial resistance, and unnecessary healthcare costs. It has been recognized for several decades that of patients receiving antimicrobial therapy, up to half receive unnecessary or inappropriate therapy, including redundant therapy. Focusing on redundant or duplicate antimicrobial therapy is 1 recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs.
Examination of treatment pathways shows that some clinicians will administer antibiotics with overlapping spectra as empiric therapy to reduce the chances that the infecting organism will be resistant to the regimen. However, aside from this use, there are very few clinical indications for using antibiotics with overlapping spectra. Additionally, overprescribing or redundant coverage can result from systemic and/or individual practitioner factors, including prescribing errors arising from the lack of knowledge of the patient's antibiotic regimen, suboptimal care coordination, or difficulties in accessing current pharmacy records. Similarly, a lack of knowledge of the antimicrobial spectra, intentional prescribing errors (eg, antibiotic combinations prescribed with intended overlap but for which there was no clinical indication), or the desire to meet patient expectations may lead to inappropriate use.
This study explored the incidence and economic impact of potentially redundant antimicrobial therapy, including dual antianaerobic agents, dual β-lactams, and dual treatment with agents active against resistant gram-positive infections (anti–methicillin-resistant Staphylococcus aureus [MRSA] agents). Because these combinations of antibiotics with redundant spectrum are so rarely clinically indicated, they could represent an early opportunity to improve antibiotic use and reduce the potential for patient harm and healthcare waste.
Abstract and Introduction
Abstract
Background. Overutilization of antimicrobial therapy places patients at risk for harm and contributes to antimicrobial resistance and escalating healthcare costs. Focusing on redundant or duplicate antimicrobial therapy is 1 recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs.
Objective. This study explored the incidence and economic impact of potentially redundant antimicrobial therapy.
Methods. We conducted a retrospective analysis of inpatient administrative data drawn from 505 nonfederal US hospitals. All hospitalized patients discharged between January 1, 2008, and December 31, 2011, were eligible for study inclusion. Potentially redundant antimicrobial therapy was identified from pharmacy records and was defined as patients receiving treatment with overlapping antibiotic spectra for 2 or more consecutive days.
Results. We found evidence of potentially inappropriate, redundant antimicrobial coverage for 23 different antimicrobial combinations in 394 of the 505 (78%) hospitals, representing a total of 32,507 cases. High-frequency redundancies were observed in 3 antianaerobic regimens, accounting for 22,701 (70%) of the cases. Of these, metronidazole and piperacillin-tazobactam accounted for 53% (n = 17,326) of all potentially redundant cases. Days of redundant therapy totaled 148,589, representing greater than $12 million in potentially avoidable healthcare costs.
Conclusions. Our study suggests that there may be pervasive use of redundant antimicrobial therapy within US hospitals. Appropriate use of antimicrobials may reduce the risk of harm to patients and lower healthcare costs.
Introduction
Overuse and inappropriate use of antimicrobials is a major public health issue and contributes to patient harm, antimicrobial resistance, and unnecessary healthcare costs. It has been recognized for several decades that of patients receiving antimicrobial therapy, up to half receive unnecessary or inappropriate therapy, including redundant therapy. Focusing on redundant or duplicate antimicrobial therapy is 1 recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs.
Examination of treatment pathways shows that some clinicians will administer antibiotics with overlapping spectra as empiric therapy to reduce the chances that the infecting organism will be resistant to the regimen. However, aside from this use, there are very few clinical indications for using antibiotics with overlapping spectra. Additionally, overprescribing or redundant coverage can result from systemic and/or individual practitioner factors, including prescribing errors arising from the lack of knowledge of the patient's antibiotic regimen, suboptimal care coordination, or difficulties in accessing current pharmacy records. Similarly, a lack of knowledge of the antimicrobial spectra, intentional prescribing errors (eg, antibiotic combinations prescribed with intended overlap but for which there was no clinical indication), or the desire to meet patient expectations may lead to inappropriate use.
This study explored the incidence and economic impact of potentially redundant antimicrobial therapy, including dual antianaerobic agents, dual β-lactams, and dual treatment with agents active against resistant gram-positive infections (anti–methicillin-resistant Staphylococcus aureus [MRSA] agents). Because these combinations of antibiotics with redundant spectrum are so rarely clinically indicated, they could represent an early opportunity to improve antibiotic use and reduce the potential for patient harm and healthcare waste.
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