Antimicrobial stewardship in the Federal Bureau of Prisons: Approaches from the national and local levels.

OBJECTIVES: To determine the impact of national and local antimicrobial stewardship measures on overall antibiotic prescribing in the Federal Bureau of Prisons (BOP).

SETTING: Care was delivered to more than 160,000 inmates in 122 BOP facilities in the United States and Puerto Rico.

PRACTICE DESCRIPTION: Medical centers and health services clinics staffed by in-house medical staff, consultants, and specialists. Staffs include a variety of disciplines, including physicians, pharmacists, dentists, nurses, infection control personnel, therapists, health services administrators, and institution executive staff.

PRACTICE INNOVATION: Innovations occurred on 2 levels: local components were used to reinforce national initiatives. Local institutions used a multidisciplinary team approach including education and focused evaluations of all antibiotic prescriptions before dispensing. National initiatives included the development of a closed formulary, clinical practice guidelines, an antimicrobial stewardship group led by pharmacy, development of tools and strategies for institutions, inclusion in the BOP strategic plan, and a drug utilization evaluation.

EVALUATION: This was a study of antimicrobial stewardship within BOP and the resultant impact on antibiotic prescriptions. In addition, one institution's antimicrobial stewardship methods were reviewed to determine the impact on antibiotic prescribing practices.

RESULTS: The total number of antibiotic prescriptions in BOP-managed institutions in fiscal year (FY) 2010 (October 2009 to September 2010) was 142,907 and progressively decreased to 105,832 in FY2015. The number of antibiotic prescriptions per 1000 inmates correspondingly decreased from 829 in FY2010 to 625 in FY2015. The overall number of antibiotic prescriptions as a percentage of total prescriptions decreased from 7.64% in FY2010 to 5.84% in FY2015.

CONCLUSION: A robust multidisciplinary antimicrobial stewardship program has likely contributed to a decrease in both the total number and the rate of antibiotic prescriptions on a per-1000-patient basis in BOP.