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oregon; psvmc; portland


Pharmacy and Pharmaceutical Sciences



• Since 2017, antimicrobial stewardship is a Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC) requirement for all acute care hospitals, critical access hospitals, and nursing care centers. •Given the current evidence supporting the utilization of extended-infusion beta-lactams, the system transitioned all its acute care facilities within the region to extended-infusion piperacillin/tazobactam (TZP) in March 2016 •According to Bauer et al, the median length of stay and hospital costs were significantly less for patients admitted to the ICU who received extended-infusion cefepime for bacteremia and/or pneumonia


The purpose of this study was to evaluate financial impact of a regional cost saving initiative by the antimicrobial stewardship program for all acute care facilities within the region, andidentify potential areas to reduce costs in the future. The study looked at the following: •Cost savings associated with reduced extended-infusion piperacillin/tazobactam administrations in 2020. •Difference in overall days of therapy and antimicrobial-associated costs between 2019-2020. •Cost savings associated with decrease in use of restricted antimicrobial agents between 2019-2020. •Potential cost savings associated with reduction in hospital length of stay related to extended-infusion cefepime use in ICU patients for the treatment of Pseudomonas aeruginosa pneumonia.


• Multi-site retrospective review of eight inpatient medical centers within the region of a large integrated healthcare system •Cost of each TZP premix bag was $10 •Cost of each hospitalized day in 2020, excluding COVID-associated expenses was between $3611.16 -$8392.71/day, depending on facility •Cost difference between 2019 and 2020 associated with change in usage of pre-specified “restricted” antimicrobial agents, as well as total costs and days of therapy associated with overall antimicrobial usage, excluding for remdesivir, were collected through Tableau reporting system


• The initiative by the antimicrobial stewardship program has resulted in substantial cost savings for all covered inpatient facilities within the region. •In 2020, the use of extended-infusion piperacillin/tazobactamresulted in saving $226,420 due to reduced administrations compared to traditional infusion. •Decreased usage in antimicrobial agents that have been considered as “restricted” by the antimicrobial stewardship team resulted in $182,837 saved in 2020. •Overall, $616,178 was saved in antimicrobial costs in 2020, after excluding costs attributed to remdesivir, due to 19,775 days reduction in overall days of therapy per 1000 patient days between 2019 and 2020. •For patients who are admitted to the ICU for pneumonia due to P. aeruginosarequiring cefepime administration, transition to extended-infusion cefepime is anticipated to save between $138,584.25-$1,385,842.5 depending on LOS reduction between 1-10 days

Future Directions Extended-infusion can optimize the time-dependent property of beta-lactams without the need for increased dose or more frequent administrations, therefore minimizing risk for development of adverse events. Given the growing prevalence of multidrug-resistant pathogens, optimizing the pharmacokinetic and pharmacodynamic parameters of current antibiotics to improve therapeutic efficacy is prudent in improving clinical outcomes, while maintaining antimicrobial sensitivity in the community and minimizing unnecessary costs. Based on current literature, the transition to extended-infusion cefepime in the treatment of P. aeruginosa pneumonia in patients requiring ICU admission may reduce hospital costs.


Graduate Medical Education



Conference / Event Name

Academic Achievement Day, 2021


Providence St. Vincent Medical Center

Financial impact of a regional antimicrobial stewardship cost saving initiative in a large integrated health care system