Antimicrobial Stewardship

What % of antibiotics prescribed are unnecessary?

50%

How did COVID-19 impact antimicrobial resistance?

Increased resistance across multiple bugs and drugs

What are the goals of antimicrobial stewardship?

Optimizing antimicrobial selection, maximizing clinical cures, reducing emergence of resistance, decreasing cost

Who is involved in the traditional model of antimicrobial stewardship?

Microbiology, nursing, physician, patient

Who is involved in the interdisciplinary model of antimicrobial stewardship?

Microbiology, pharmacy, nursing, ID physician, attending physician, patient

What are the core elements of hospital antimicrobial stewardship programs?

Leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, education

What is involved in the leadership commitment core element of hospital antimicrobial stewardship programs?

Administration and senior leadership making stewardship a priority, including it in job descriptions, ensuring protected time for stewardship activities, and other support

What is involved in the accountability and pharmacy expertise core element of hospital antimicrobial stewardship programs?

There is a designated leader of the team who is responsible to outcomes. This person is most commonly a physician with a pharmacist co-leader

What is involved in the action core element of hospital antimicrobial stewardship programs?

Prospective audit and feedback to identify and correct suboptimal care. Formulary restriction and pre-authorization to restrict antimicrobial use. Changes in practice guidelines in individual facilities, standardized order sets

What are the advantages of taking antimicrobial stewardship actions to prevent unnecessary prescribing?

initial use of broad spectrum therapy, Narrows therapy, if appropriate, encourage better prescribing, decreased inappropriate prescribing, decreased ADRs, decreased costs

What are the disadvantages of taking antimicrobial stewardship actions to prevent unnecessary prescribing?

Prescriber reluctance to change, inappropriate narrowing of therapy

How can B-lactams be optimized?

Extend the infusion time

What are the benefits of IV --> PO conversion?

Increased comfort and mobility, decreased hospital stay and exposure to nosocomial pathogens, decreased risk of phlebitis, decreased costs

(T/F) It is CRITICAL to confirm all penicillin and beta lactam allergies to ensure appropriate antimicrobial therapy

True

In a patient with a history of a mild reaction to PCN (rash, itching, family history), how should you assess for a PCN allergy?

Direct challenge or graded challenge

In a patient with a history of a moderate reaction to PCN (urticaria, flushing/redness, wheezing), how should you assess for a PCN allergy?

Graded challenge or PST

In a patient with a history of a severe reaction to PCN (IgE-mediated reaction or high risk unknown), how should you assess for a PCN allergy?

PST or desensitization

How can antimicrobial stewardship be applied in microbiology?

Ensure cultures are properly and CONSISTENTLY ordered, collected, and transported including timely identification of pathogens and susceptibility testing. Antibiogram development

How should antimicrobial stewardship processes be tracked and reported?

Metrics reviewed bi-monthly and reported to antibiotic subcommittee or pharmacy and therapeutics committee

How should antibiotic use measures be tracked and reported?

DOT/1000 pt days, percent of resistant pathogens, secondary infections, ABX drug budget

How can antimicrobial stewardship education be carried out in a hospital?

Individual prescriber reporting, committee meetings, antibiograms, 1:1 education, community education

What things can pharmacists do to encourage antimicrobial stewardship?

Automatic IV to PO conversion, renal dosing, pharmacokinetic services, avoiding duplicate therapies, automatic stop orders, detection and prevention of antibiotic-related DDIs, monitoring of antimicrobial shortages