Participation of clinical pharmacists without specialized infectious diseases training in antimicrobial stewardship

Abstract Background Carbapenem-resistant gram-negative organisms are a continuously mounting threat, underscoring the need for effective antimicrobial stewardship interventions to improve the use of carbapenems. We sought to implement several multidisciplinary antimicrobial stewardship interventions beginning in January 2019 in an effort to reduce unnecessary meropenem use and the incidence of carbapenem-resistant gram-negatives. Methods Prospective audit and feedback was utilized daily in combination with weekly stewardship rounds between an Infectious Diseases pharmacist and physician in the Intensive Care Units. A second Infectious Diseases physician attended weekly interdisciplinary rounds on meropenem high-use units. Meropenem Days of Therapy (DOT) per 1,000 patient days and the incidence of meropenem resistant Pseudomonas aeruginosa and Klebsiella pneumoniae were compared by the chi-square test of proportions. Results Between 2018 and 2019 the institution’s meropenem DOT per 1,000 patient days decreased 33%, from 57 to 38 days per 1,000 patient days (difference, 19 days per 1,000 patient days; p< 0.001). In the hospital antibiogram, the meropenem susceptibility of Pseudomonas aeruginosa over the same time period increased from 71% to 77% of isolates (difference, 6%; p = 0.009). A non-significant decrease in the susceptibility of meropenem to Klebsiella pneumoniae was also observed from 92 to 90% (difference, 2%: p = 0.1658). Conclusion These data support the need for antimicrobial stewardship efforts targeting broad-spectrum antimicrobials such as meropenem. In the setting of a sustained decrease in meropenem use over 12 months, we observed a significant improvement in the percent susceptibility rate of Pseudomonas aeruginosa to meropenem for the first time in five years. Disclosures All Authors: No reported disclosures

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2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapya

Clinical Infectious Diseases ◽

10.1093/cid/ciy867 ◽

2018 ◽

Vol 68 (1) ◽

pp. 1-4 ◽

Cited By ~ 19

Author(s):

Anne H Norris ◽

Nabin K Shrestha ◽

Genève M Allison ◽

Sara C Keller ◽

Kavita P Bhavan ◽

...

Keyword(s):

Clinical Practice ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Healthcare Professionals ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Infusion Catheter

Abstract A panel of experts was convened by the Infectious Diseases Society of America to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

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42. A Pharmacist-Led Intervention to Decrease Anaerobic Coverage for Hospitalized Patients with Community-Acquired Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.087 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S44-S45

Author(s):

Maxx O Enzmann ◽

Courtney M Pagels ◽

Emily J Perry ◽

Justin Jones ◽

Paul Carson

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Community Acquired Pneumonia ◽

Lung Abscess ◽

American Thoracic Society ◽

Hospitalized Patients ◽

Guidance Document ◽

Antibiotic Exposure ◽

Antibiotic Regimen ◽

Days Of Therapy

Abstract Background Community-acquired pneumonia (CAP) is frequently mis-categorized as aspiration pneumonia, prompting the addition of anaerobic coverage to the antibiotic regimen. In our institution, this usually takes the form of adding metronidazole to ceftriaxone. The 2019 American Thoracic Society and Infectious Diseases Society of America CAP guidelines recommend anaerobic coverage only for hospitalized patients with a suspected lung abscess or empyema. The objective of this study was to determine if a pharmacist-led workflow could increase adherence to the 2019 CAP guideline recommendations by limiting anaerobic coverage to those rare occasions. Methods The hospital antimicrobial stewardship committee approved a pharmacist workflow and guidance document which outlines criteria to evaluate appropriateness of anaerobic coverage for hospitalized patients with CAP and no other indications for antibiotics. If anaerobic coverage is not indicated, the pharmacist submits a standardized message to the treating provider via the electronic medical record, recommending discontinuation of metronidazole. This workflow was implemented on October 3, 2019. Metronidazole days of therapy (DOT) per 1000 patient days in quarters 1 through 4 of 2019 and quarter 1 of 2020 were collected as well as percent acceptance of documented pharmacist interventions from October 3, 2019 until March 31, 2020. Results Between October 3, 2019 and March 31, 2020, a total of 221 interventions were made by pharmacists to discontinue metronidazole in hospitalized CAP patients where anaerobic coverage was not indicated. Out of those 221 interventions, 164 (74%) were accepted by providers and only 57 (26%) were rejected. The DOT per 1000 patient days of metronidazole was assessed for the three quarters prior to our intervention and the two quarters after the intervention. Compared to the three quarters prior, metronidazole DOT per 1000 patient days decreased by 26.6% for the two quarters following implementation of the pharmacist-led intervention (Figure 1). Figure 1: Metronidazole DOT per 1000 patient days from January 1, 2019 through March 31, 2020. Vertical line indicates when pharmacist workflow was implemented. Conclusion A pharmacist antimicrobial stewardship intervention at our institution increased adherence to CAP guidelines and decreased unnecessary antibiotic exposure in hospitalized CAP patients when anaerobic coverage was not indicated. Disclosures All Authors: No reported disclosures

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Taking on Clostridioides difficile

Preventing Hospital Infections ◽

10.1093/med/9780197509159.003.0010 ◽

2021 ◽

pp. 141-157

Author(s):

Jennifer Meddings ◽

Vineet Chopra ◽

Sanjay Saint

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Clostridium Difficile ◽

Tract Infection ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Infection Prevention ◽

Hospital Staff ◽

Clostridioides Difficile

The adaptive approach used in the previous chapters to prevent catheter-associated urinary tract infection (CAUTI) is applied to an initiative to prevent Clostridioides difficile (formerly Clostridium difficile) infection. These two initiatives differ regarding their scope, the members of their teams, and the elements of their bundles. For preventing C. difficile, for example, the most important bundle item is antimicrobial stewardship since the use of broad-spectrum antibiotics vastly increases a person’s risk of becoming infected. Infectious diseases physicians or clinical pharmacists are to examine the circumstances of antimicrobial prescriptions they have filled to see whether they meet infection prevention standards; if not, the prescribing physician will receive prompt feedback. Differences aside, the basic elements of the CAUTI framework apply, from the C-suite’s decision to go ahead with the initiative to the tactics used to sell the C. difficile bundle to the hospital staff.

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Map the Gap: Mapping the Spread of Antimicrobial Stewardship Programs with the Infectious Diseases Workforce

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1328 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S511-S511

Author(s):

Aditya Shah ◽

Sarah Sansom

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship

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1894. Antimicrobial Stewardship in the Intensive Care Unit: Survey of Critical Care and Infectious Diseases Physicians

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1550 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S543-S543

Author(s):

M Cristina Vazquez Guillamet ◽

Jason Burnham ◽

Maria Perez ◽

Marin Kollef ◽

Constantine Manthous ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Infectious Diseases ◽

Antimicrobial Stewardship

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Impact of Antimicrobial Stewardship Interventions on Antimicrobial Utilization in Asymptomatic Bacteriuria

Hospital Pharmacy ◽

10.1177/0018578719888911 ◽

2019 ◽

pp. 001857871988891 ◽

Cited By ~ 1

Author(s):

Punit J. Shah ◽

Chiamaka Ike ◽

Meghan Thibeaux ◽

Emilyn Rodriguez ◽

Shermel-Edwards Maddox ◽

...

Keyword(s):

Real Time ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Asymptomatic Bacteriuria ◽

Control Phase ◽

Clinical Pharmacists ◽

Antimicrobial Utilization ◽

Positive Urine ◽

Interdisciplinary Interventions ◽

The Impact

Background: Antimicrobial therapy for asymptomatic bacteriuria (ASB) is often unnecessary and is a common reason for inappropriate antimicrobial use in hospitalized patients. Unnecessary ASB treatment leads to collateral damage such as resistance, and Clostridium difficile infections. This study evaluated the impact of interdisciplinary antimicrobial stewardship interventions on antimicrobial utilization in ASB. Methods: This was a quasi-experimental institutional review board (IRB)-approved study evaluating the impact of antimicrobial stewardship on antibiotic utilization for ASB in a pilot medical-surgical unit. The control phase was from August-October 2017 and the postintervention phase was from December-March 2018. In the control phase, electronic medical records of patients with positive urine cultures were retrospectively reviewed. Patients were classified as either having ASB or urinary tract infection (UTI) based on the absence or presence of UTI symptoms documented in the medical record. The intervention phase consisted of educational in-services to providers, nurses, and pharmacists. Clinical pharmacists for the pilot unit utilized an electronic real-time surveillance system to identify patients with positive urine cultures. With nurses’ collaboration, clinical pharmacists classified these patients as either having UTI or ASB. Stewardship interventions were made in real-time to discontinue antibiotics in patients with ASB. Results: There were 65 and 77 patients with bacteriuria in the pre- and postintervention phases. Among these, ASB was present in 29 (45%) and 27 (35%) patients, respectively. After excluding those receiving antibiotics for concurrent nonurinary indications, the combination of education with pharmacist and nursing interventions decreased unnecessary ASB treatment from 18 (62%) to 6 (22%) patients (relative risk: 0.36, 95% confidence interval: 0.16-0.72, P = .003). Conclusion: The findings of this study highlight the importance of interdisciplinary interventions in reducing unnecessary antimicrobial therapy for the treatment of ASB. With increasing antimicrobial resistance, healthcare institutions should evaluate the role of these interdisciplinary interventions to reduce unnecessary treatment for ASB.

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A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00307-20 ◽

2020 ◽

Vol 64 (8) ◽

Cited By ~ 1

Author(s):

Jacqueline T. Bork ◽

Kimberly C. Claeys ◽

Emily L. Heil ◽

Mary Banoub ◽

Surbhi Leekha ◽

...

Keyword(s):

Propensity Score ◽

Infectious Diseases ◽

Propensity Score Matching ◽

Antimicrobial Stewardship ◽

Positive Impact ◽

Hospitalized Patients ◽

Audit And Feedback ◽

Medical Specialties ◽

Infectious Diseases Consultation ◽

The Impact

ABSTRACT Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; P < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.

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