Providing background for antimicrobial stewardship strategy using costs data: a mission impossible?

Background: In the context of intensive care units (ICUs), antimicrobial stewardship (AS) projects are often hampered by the lack of dedicated human resources. Added to this is the limited effectiveness of the measurement parameters available to date. The combination of these two factors heavy impacted either the possibility of containing healthcare costs or limiting the increase of infections induced by microorganisms resistant to antibiotics. Methods: We tested the possibility of using administrative cost reports produced every six months by the Management Control Structure of the ‘Città della Salute e della Scienza’ Hospital of Turin (Italy) to obtain a reliable estimate of the consumption of antimicrobial drugs of all ICUs that make up the Department of Anesthesia and Intensive Care. Results: It was found that antimicrobial drugs account for about 50% of drug cost differences with huge differences between the eight ICUs that make up the Department of Anesthesia and Intensive Care. Antifungal drugs represented altogether a percentage of expenditure of about 30% of the total expenditure on antimicrobial drugs. Multi-drug resistant germs, especially Carbapenem resistant-Klebsiella pneumonia subtype KPC, Acinetobacter baumannii and extended spectrum beta-lactamase (ESBL) Escherichia coli, were higher in 2016 in comparison with 2015. Conclusions: From a methodological point of view, it emerged that the implementation of this approach, not involving human resources and easily applicable repeatedly and continuously in the context of the various intensive structures that make up the Department of Anesthesia and Intensive Care, seems capable to provide the appropriate basis for an internal comparison followed by the implementation of more complex AS strategies.