Antimicrobial stewardship cuts drug costs in septic surgery without raising mortality

A multidisciplinary antimicrobial stewardship program introduced at a 24-bed septic surgery unit in Hungary was associated with a sharp drop in antibiotic spending and shorter courses of therapy, while 30-day mortality remained essentially unchanged, according to a retrospective before-after study published in Antimicrobial Resistance & Infection Control. The program, implemented at the Septic Surgery Unit of Somogy County Kaposi Mór Teaching Hospital, produced a 25.09% reduction in total drug procurement costs, from 6,451,451 Hungarian forints to 4,832,680 forints over the one-year post-intervention period, a difference the authors report as statistically significant (p = 0.006).

The study followed ORION and SQUIRE 2.0 reporting guidelines and compared two one-year windows: a pre-intervention period from 1 October 2022 to 30 September 2023 and a post-intervention period from 1 October 2023 to 30 September 2024. The researchers evaluated defined daily doses (DDD) and days of therapy (DOT) per 1,000 patient-days, mean duration of antibiotic therapy per treated patient, gross institutional procurement costs, length of stay, and 30-day all-cause mortality from admission. Continuous variables were compared with independent samples t-tests, and categorical variables with chi-square or Fisher’s exact tests.

One of the more counterintuitive findings concerns consumption metrics. Cumulative defined daily doses actually rose by 23.00% after the program began, from 4,037.44 to 4,965.85 DDD (p = 0.003), equivalent to an increase from 673.52 to 832.36 DDD per 1,000 patient-days. Active antibiotic exposure, measured in days of therapy, shifted from 626.88 to 691.26 DOT per 1,000 patient-days. The authors characterize this as an administrative expansion in cumulative DDD metrics rather than a signal of overuse, because it occurred alongside cost savings and shorter individual treatment courses.

At the patient level, the mean duration of antibiotic therapy per treated patient fell from 5.68 days (standard deviation 3.22) to 5.30 days (standard deviation 3.23), a statistically significant decrease (p = 0.028).

The program was also accompanied by changes in healthcare-associated pathogen patterns. The incidence density of glycopeptide-resistant Gram-positive cocci decreased by 87.07% (p = 0.039), and methicillin-resistant staphylococci decreased by 74.13% (p = 0.034). The authors note, however, that these reductions were observed in conjunction with reinforced barrier infection control measures, so the stewardship program alone cannot be credited with the full effect.

Safety was monitored as a core endpoint. All-cause 30-day mortality from admission was 10.03% in the pre-intervention year and 9.00% in the post-intervention year, a difference that was not statistically significant (p = 0.545). The authors interpret this as confirming non-inferior clinical safety, meaning the cost savings and shorter therapy durations were not achieved at the price of higher early mortality in this patient population.

The study’s design carries inherent limitations typical of before-after comparisons at a single unit. Because the analysis is retrospective and uncontrolled, temporal trends, seasonal variation in septic surgical admissions, and concurrent infection control interventions could each contribute to the observed changes, and the reported associations do not establish that the stewardship program alone caused the reductions in cost, therapy duration, or resistant pathogen incidence. The mortality comparison, while reassuring, was powered only as a safety monitoring endpoint rather than a formal non-inferiority trial.

In this septic surgery cohort, the combination of lower procurement spending, a higher share of oral therapy, shorter mean treatment courses, and stable 30-day mortality suggests that reducing unnecessary antibiotic exposure and expenditure is achievable without compromising short-term patient outcomes, even when aggregate consumption metrics move in the opposite direction.

Subject of Research: Clinical and economic outcomes of a multidisciplinary antimicrobial stewardship program in a hospital septic surgery unit

Article Title: Clinical and economic impact of a multidisciplinary antimicrobial stewardship program in a septic surgery unit

Article References: Biró, A., Sáfár, L., Merczel, S., & Káposztás, Z. (2026). Clinical and economic impact of a multidisciplinary antimicrobial stewardship program in a septic surgery unit. Antimicrobial Resistance & Infection Control. https://doi.org/10.1186/s13756-026-01853-1

Image Credits: AI Generated

DOI: 10.1186/s13756-026-01853-1

Keywords: antimicrobial stewardship, septic surgery, antibiotic costs, defined daily dose, days of therapy, IV-to-oral conversion, 30-day mortality, methicillin-resistant staphylococci, infection control, retrospective cohort study, Clinical, economic