Email updates

Keep up to date with the latest news and content from BMC Proceedings and BioMed Central.

This article is part of the supplement: International Conference on Prevention & Infection Control (ICPIC 2011)

Open Access Oral presentation

Initiating an antimicrobial stewardship program with limited resources

JM Boyce1*, A Tauman2, J Kozakiewicz3, A Fisher1, W Hung3, T Halpert3 and A Karjoo3

  • * Corresponding author: JM Boyce

Author Affiliations

1 Medicine, Hospital of Saint Raphael, New Haven, USA

2 VHA, Southport, CT, USA

3 Pharmacy, Hospital of Saint Raphael, New Haven, USA

For all author emails, please log on.

BMC Proceedings 2011, 5(Suppl 6):O41  doi:10.1186/1753-6561-5-S6-O41

The electronic version of this article is the complete one and can be found online at:

Published:29 June 2011

© 2011 Boyce et al; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction / objectives

Antimicrobial stewardship (AMS) is an important strategy for improving patient safety, but many hospitals have limited resources to devote to AMS. We describe formation of an AMS program in a 400-bed hospital with relatively limited resources.


We developed an AMS program, headed by a pharmacist and infectious diseases (ID) physician. Drug utilization reviews identified an expensive, broad-spectrum agent (piperacillin-tazobactam [P-T]) for initial targeting. An AMS form for listing clinical data and recommendations was developed. A daily list of patients receiving P-T was used to identify target patients for intervention. The pharmacist and ID physician made rounds on wards, placed AMS forms in patient charts, and spoke to caregivers regarding recommendations. Intravenous to oral conversions were performed by pharmacists. After 6 months of AMS activity revealed cost savings, hospital administration approved a ½-time pharmacist position for AMS.


In the first complete year of the AMS program, the hospital spent $277,833 less on anti-infectives (11% reduction in cost/adjusted patient-day) than in the previous year. Of this amount, $172,865 less was spent specifically for broad-spectrum agents (22% reduction in cost/adjusted patient-day for broad-spectrum agents). P-T purchases decreased by 20%, levofloxacin by 10% and vancomycin by 19% compared to the previous year. 90% of recommendations were accepted by caregivers. The number of new, nosocomial Clostridium difficile diarrhea cases/10,000 patient-days decreased by 28% compared to the previous year.


An AMS program implemented with relatively few resources resulted in cost savings to the hospital and improved patient care.

Disclosure of interest

None declared.