Addressing the Unique Challenges Small Hospitals Face When Implementing Antibiotic Stewardship Programs

By Chris Cook, PharmD, Ph.D.

In a follow-up study on antibiotic stewardship at small community hospitals, researchers at Intermountain Healthcare and University of Utah Health in Salt Lake City performed a study to identify how small community hospitals (<200 beds) can implement effective antibiotic stewardship programs.

As described by Intermountain Healthcare, “For the 15 month-study, researchers compared the impact of three types of antibiotic stewardship programs in 15 small hospitals within the Intermountain Healthcare system in Utah. They found the most effective program used infectious disease physicians and pharmacists at a central hospital working with local pharmacists to reduce broad-spectrum antibiotic use by nearly 25 percent and total antibiotic use by 11 percent.”

“The bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can really reduce the inappropriate use of antibiotics,” said Andrew Pavia, MD, professor of pediatrics at University of Utah Health and a co-author of this study. “And more appropriate use of antibiotics will help address the growing problem of ‘superbugs’ that can cause costly and dangerous infections.”

The parameters of the 3 separate study group hospitals are outlined below:

Program 1:

  • Implemented basic education to physicians and staff on antibiotic stewardship programs
  • Provided a 24/7 infectious disease hotline staffed by infectious disease specialists

Program 2:

  • Provided more advanced antibiotic stewardship education
  • Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
  • Implemented a pharmacy-based initiative in which local pharmacists reviewed use of broad-spectrum antibiotics and provided recommendations for improvement to prescribers
  • Certain broad-spectrum antibiotics were restricted and only local pharmacy staff could approve their use

Program 3:

  • Provided more advanced antibiotic stewardship education
  • Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
  • Implemented a pharmacy-based initiative in which local pharmacists reviewed most antibiotic prescriptions and provided recommendations for improvement to prescribers
  • Certain broad-spectrum antibiotics were restricted and only centralized infectious diseases pharmacists could approve their use
  • Infectious disease specialists reviewed selected microbiology results and spoke with local providers about recommendations for treatment

Before the study, none of the small community hospitals within the Intermountain system had a formalized antibiotic stewardship program. Hospitals were randomly assigned to one of three study groups to determine which was most effective in reducing broad-spectrum antibiotic use.

The researchers determined the most effective program used infectious disease physicians and pharmacists at a central hospital working with local pharmacists to reduce broad-spectrum antibiotic use (Group 3). This approach saw a 25 percent reduction of broad spectrum antibiotics and a reduction in total antibiotic use by 11 percent. There was no significant improvement in antibiotic reduction in groups 1 and 2.

“Having an antibiotic stewardship program in place that ensures the right antibiotic is used for the right patient, at the right time, in the right dose and route, and for the right duration will help us protect the effectiveness of the antibiotics we use,” said Eddie Stenehjem, MD, an infectious disease specialist with Intermountain Medical Center and lead author of the study. “The challenge has been knowing how these programs can be implemented in small hospitals, where, historically, they’ve been absent, even though antibiotic use rates in small hospitals are very similar to large hospitals, where the programs are typically found.”


Opinions expressed in this article are not necessarily those of bioMérieux, Inc.


Christopher Cook, PharmD, Ph.D.

Christopher Cook has over 20 years’ experience in pharmacy practice ranging from academia to clinical practitioner and outcomes researcher. Dr. Cook is currently the Senior Director, Antimicrobial Stewardship Customer Support at bioMérieux, Inc.. He also serves on the National Quality Forum Patient Safety Committee. Prior to joining bioMerieux, Dr. Cook served as a Clinical Professor at the University Of Georgia College Of Pharmacy.

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