PHAR 542: Antimicrobial Stewardship

Basic Interventions

1. Preauthorization

   1. strategy to improve antibiotic use by requiring clinicians to get approval for certain antibiotics BEFORE they are prescribed

   2. typically require either ID authorization or ID consult

2. Prospective audit and feedback

   1. intervention that engages providers AFTER an antibiotic is prescribed

   2. different models exist but typically focus on high cost, toxicity, or broad spectrum antibiotics (for ex, review of clindamycin use)

Institution specific Practice Guidelines

1. ASPs can develop facility specific clinical practice guidelines coupled with a dissemination and implementation strategy

Reduction of CDI

1. ASP interventions can reduce use of antibiotics associated with a high risk of Clostridium difficile infection (CDI)

   1. Focus on clindamycin and broad- spectrum antibiotics, esp cephalosporins and quinolones (typically via prospective audit and feedback)

IV to PO Conversion

1. Increase both appropriate use of oral antibiotics for initial therapy and the timely transition of patients from IV to oral antibiotics

   1. Reduced drug costs

   2. Reduced length of hospital stay

   3. Patient convenience

1. Typically done for antibiotics with high bioavailability (>90%)

Allery Assessment

ASPs can promote allergy assessments and PCN skin testing in patients with history of beta-lactam allergy

Antibiograms

Development of stratified antibiograms over nonstratified hospital wide antibiograms

1. Used by clinicians to

   1. assess local susceptibility rates

   2. aid in selective empiric antibiotic therapy

   3. monitor resistance trends over time within an institution

Rapid Diagnostic Testing

typically used on specific types of cultures to allow RAPID identification of microorganisms (usually within hours) and some resistance genes via PCR

1. ensures treatment appropriate

2. Faster deescalation

Selective MIC reporting

1. Reporting susceptibility data for a limited number of antibiotics instead of all antibiotics tested

   1. Some factors considered

   2. Formulary

   3. Site of infection

2. Improves appropriateness of prescriptions