Economic impact of a rational use of antibiotics in intensive care

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Abstract
Objective: To evaluate the economic impact of a rational policy in antibiotic treatment. Design: Comparative study with a retrospective and a prospective part. Setting: An 11-bed intensive care unit (ICU) in a general hospital. Patients: All patients admitted to the unit in 1994, 1995 and 1996. Interventions: In 1995, a program of cost control was started and a contract of agreed objectives signed with the director of the hospital. This contract included a commitment to refund the eventual savings in order to improve the quality of care. Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy. Measurements and results: The cost of antibiotic therapy, the patients' characteristics and the incidence of nosocomial infection were compared prior to and during the program. The expenses for antibiotic drugs decreased by 19 % in 1995 and by 22 % in 1996. Most of the savings were refunded to the ICU and contributed to the employment of an additional nurse and the purchase of new material. In number of patients, type of disease, mean age, Simplified Acute Physiology Score, occupancy rate, length of stay, omega score, artificial ventilation, readmission within 7 days, mortality and incidence of nosocomial infection, no significant difference was found. Conclusions: We proved a positive economic impact of a rational policy in antibiotic therapy realized with a contract of agreed objectives. The savings made while applying our program of cost control were used to improve the quality of care.

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