Development of a Centralized Antimicrobial Stewardship Program Across a Diverse Health System and Early Antimicrobial Usage Trends

In a diverse health system with varying levels of onsite antimicrobial stewardship resources, a model integrating centralized Infectious Diseases and Stewardship experts with local pharmacists yielded similar improvements in antimicrobial usage to sites with more local resources. Background Expanding antimicrobial stewardship to community hospitals is vital and now required by regulatory agencies. UPMC instituted the Centralized Health system Antimicrobial Stewardship Efforts (CHASE) Program to expand antimicrobial stewardship to all UPMC hospitals regardless of local resources. For hospitals with few local stewardship resources, we used a model integrating local non-Infectious Diseases (ID) trained pharmacists with centralized ID experts. Methods Thirteen hospitals were included. Eleven were classified as robust (4) or nonrobust (7) depending on local stewardship resources and fulfillment of Centers for Disease Control and Prevention core elements of hospital antimicrobial stewardship. In addition to general stewardship oversight at all UPMC hospitals, the centralized team interacted regularly with nonrobust hospitals for individual patient reviews and local projects. We compared inpatient antimicrobial usage rates at nonrobust versus robust hospitals and at 2 UPMC academic medical centers. Results The CHASE Program expanded in scope between 2018 and 2020. During this period, antimicrobial usage at these 13 hospitals decreased by 16% with a monthly change of -4.7 days of therapy (DOT)/1000 patient days (PD) (95% confidence interval [CI], -5.5 to -3.9; P < .0001). Monthly decrease at nonrobust hospitals was -3.3 DOT/1000 PD per month (-4.5 to -2.0, P < .0001), similar to rates of decline at both robust hospitals (-3.3 DOT/1000 PD) and academic medical centers (-4.8 DOT/1000 PD) (P = .167). Conclusions Coordinated antimicrobial stewardship can be implemented across a large and diverse health system. Our hybrid model incorporating a central team of experts with local community hospital pharmacists led to usage decreases over 3 years at a rate comparable to that seen in larger hospitals with more established stewardship programs.