Carolinas HealthCare System

Overprescribing antibiotics is a key contributor of antibiotic resistance, which can lead to healthcare acquired infections, infections that are much harder to treat and even death. The Carolinas HealthCare System Antimicrobial Support Network helps providers make the best decisions for the selection, dosage and duration of antibiotics treatments for patients, helping prevent antibiotic resistance and helping to ensure the effectiveness of antibiotics for affected patients.

Reducing C.diff Rates

Through the HEN and other efforts, our goal is to decrease rates of infections resistant to multiple antibiotics and “superbugs,” like Clostridium Difficile (C.diff). C. diff is a type of bacteria that causes inflammation of the colon, diarrhea and usually occurs in people who have other illnesses or conditions that require antibiotics over a long period of time.1 One way to prevent C. diff is to avoid prescribing unnecessary antibiotics.

Since we started LEAPT, most of our facilities have not reduced their rates of C. diff below their respective baselines. We have performed analyses to determine the cause of this and early results show that many of our patients diagnosed with C. diff may actually be infected prior to admission. This means C. diff is acquired from the community, not the hospital setting. These early results show us that our work with antibiotic stewardship is needed outside hospital walls.

Clostridium Difficile (C.diff) Rates (October 2013 - July 2014)

LEAPT FacilityBaseline RateC.diff casesPatient DaysC.diff rate/10,000 patient days
Carolinas Medical Center 6.74 127 195,522 6.49
CMC-Mercy 7.56 18 26,900 6.69
CHS NorthEast 5.58 49 83,169 5.89
CHS Pineville 6.84 35 50,337 6.95
CHS University 1.42 11 16,724 6.58
CHS Union 4.54 5 22,886 2.18
Total 6.19 245 395,538 6.19

Note: Facilities’ baseline rates were calculated using data from October 2012-September 2013.

Other Antimicrobials

Our facilities continue to monitor their performance for other selected antibiotics that have been shown to increase resistant organisms that can lead to infections difficult to treat.

    • Anti-Pseudamonal Beta Lactams are broad-spectrum antibiotics and should be used for serious, life-threatening infections or when someone is resistant to antibiotics. Overuse can increase the likelihood of antibiotic resistance.
    • Fluoroquniolone overuse is associated with both C. diff infections and resistance.
    • Anti-MRSA antibiotics were monitored because they are specific for the treatment of MRSA. They should only be used when MRSA is confirmed to avoid resistance.

We have reduced use for each of the selected antibiotics, with most of our facilities reaching the 20 percent goal for fluoroquinolones in July 2014, as shown in the table below.

Days of Antibiotics per 1,000 Patient Days, Specific Utilization
January-September 2013 baseline data; January-September 2014 performance data

(Positive percentages mean improvement.)

 Anti-Pseudamonal Beta LactamsFluoroquinolonesAnti-MRSA Agents
LEAPT Facility Baseline Performance Improvement Baseline Performance Improvement Baseline Performance Improvement
Carolinas Medical Center 130.5 121.0 7.3% 96.4 73.7 23.5% 108.2 96.8 10.6%
CMC-Mercy 135.7 131.0 3.5% 149.3 115.8 25.5% 156.7 154.4 1.5%
CHS NorthEast 156.2 143.8 7.9% 152.4 136.8 10.3% 143.0 131.8 7.8%
CHS Pineville 126.0 129.2 -2.6% 163.2 145.6 10.8% 117.0 116.7 0.2%
CHS University 127.9 115.2 9.9% 190.6 145.8 23.5% 97.72 89.46 8.45%
CHS Union 170.5 148.1 13.1% 228.8 182.3 20.3% 185.8 151.7 18.3%

Our facilities are also showing progress in reducing the number of days patients are taking antibiotics (Days of Therapy). Reducing the number of days patients take antibiotics when clinically appropriate is another way to reduce resistance and secondary infections.

Days of Therapy* per 1,000 Patient Days

January-September 2013 baseline data; January-September 2014 performance data

LEAPT FacilitySystem LEAPT BaselineFacility PerformanceImprovement
Carolinas Medical Center 451.4 410.6 9.1%
CMC-Mercy 568.2 500.3 11.9%
CHS NorthEast 595.9 539.0 9.5%
CHS Pineville 541.4 518.1 4.3%
CHS University 525.3 468.9 10.7%
CHS Union 730.4 599.4 17.9%

* Days of therapy refer to the number of days patients are on antibiotics

Our efforts to become better stewards of antibiotics have reduced the dollars spent on antibiotics, as shown below. The dollars shown in the table represent savings to the hospital – by cutting costs to the hospital, we reduce costs to our patients

Antimicrobial Cost* per 1,000 Adjusted Patient Days
January-August 2013 baseline data; January-August 2014 performance data

LEAPT FacilitySystem LEAPT BaselineFacility PerformanceImprovement
Carolinas Medical Center $12,764 $11,427 10.5%
CMC-Mercy $21,032 $12,374 41.2%
CHS NorthEast $7,604 $6.481 14.8%
CHS Pineville $7,195 $6,776 5.8%
CHS University $4,810 $4,141 13.9%
CHS Union $3,684 $3,777 -2.5%

* Antimicrobial cost refers to the amount facilities spend on antimicrobials