Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center

Abstract Background Pharmacists with residency training in infectious diseases (ID) optimize antimicrobial therapy outcomes in patients and support antimicrobial stewardship (AS) programs. Although most ID residencies are accredited and assessed by certain standards, the degree to which these programs are similar is not known. Methods A 19-item, cross-sectional, multicentered, electronic survey was distributed via e-mail to pharmacy residency program directors (RPDs) of all 101 second-year postgraduate (PGY-2) ID residency programs in the United States. Results Survey responses were collected from 71 RPDs (70.3%); 64.8% were associated with an academic medical center and 97.2% focused primarily in adult ID. Rotations in the microbiology laboratory, adult AS, and adult ID consult were required in 98.6% of residency programs. Only 28.2% of responding programs required pediatric AS and pediatric ID consult rotations. Programs at academic medical centers were more likely to offer immunocompromised host ID consult (P = .003), pediatric ID consult (P = .006), and hospital epidemiology (P = .047) rotations but less frequently offered outpatient AS (P = .003), viral hepatitis clinics (P = .001), and travel medicine clinics (P = .007) rotations compared to programs at nonacademic medical centers. Residents were frequently involved in AS committees (97.2%), pharmacokinetic dosing of antimicrobials (83.1%), precepting pharmacy trainees (80.3%), and performing research projects (91.5%). Conclusions The PGY-2 ID pharmacy residency programs demonstrated consistency in required adult ID consult, antimicrobial management activities, committee service, and teaching and research opportunities. Pediatric experiences were less common. The PGY-2 ID residency programs prepare pharmacists to become antimicrobial stewards for adult patients.

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Analysis of an Infectious Diseases Pharmacist on Call Pager Program to Inform Educational Efforts

Journal of Pharmacy Technology ◽

10.1177/8755122517708207 ◽

2017 ◽

Vol 33 (4) ◽

pp. 146-150

Author(s):

Elise M. Gilbert ◽

Nathaniel J. Rhodes ◽

Milena M. McLaughlin ◽

Jessica M. Cottreau ◽

Marc H. Scheetz ◽

...

Keyword(s):

Infectious Diseases ◽

Health Care Providers ◽

Medical Center ◽

Academic Medical Center ◽

Temporal Trends ◽

Question Type ◽

Care Providers ◽

Educational Initiatives ◽

Academic Medical ◽

Secondary Objective

Background: An on call infectious diseases (ID) pharmacist may be used as a resource for physicians, pharmacists, and other health care providers to help answer questions regarding anti-infective agents. Objective: To assess type, requestor, resources dedicated, and temporal trends of questions received through an ID pharmacist on call pager program. A secondary objective was to gather insight as to how this information was utilized to inform educational initiatives. Methods: This was a retrospective study of questions received by the ID pharmacist on call via pager at a large academic medical center. Question data were documented in a central database and analyzed to assess temporal trends and question type, and qualitatively analyzed to determine areas for targeted educational efforts. Results: The ID pharmacist on call recorded 545 questions during the 1-year study period; questions were composed of various antimicrobial agent–related queries, including antibiotic spectrum and selection (n = 251, 46.1%), dosing of antimicrobials (n = 195, 35.8%), and drug monitoring (n = 26, 4.8%). Targeted educational initiatives secondary to questions received included pharmacist education regarding the use of polymyxin antibiotics and antibiotic dosing protocol updates. Conclusions: An ID pharmacist on call pager program was utilized to inquire about antibiotic spectrum and selection for the majority of questions. Records of questions received may be utilized to direct educational efforts and create or revise targeted resources for pharmacists and other clinicians.

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Automatic ID Consultation for Inpatients With COVID-19: Point, Counterpoint, and a Single-Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa318 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Cynthia T Nguyen ◽

Gregory Olson ◽

Mai T Pho ◽

Alison K Lew ◽

David Pitrak ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Single Center Experience ◽

Academic Medical ◽

Clinician Satisfaction ◽

Potential Benefits ◽

Infectious Diseases Consultation ◽

The Impact

Abstract There are many unknowns with regard to COVID-19 clinical management, including the role of Infectious Diseases Consultation (IDC). As hospitalizations for COVID-19 continue, hospitals are assessing how to optimally and efficiently manage COVID-19 inpatients. Typically, primary teams must determine when IDC is appropriate, and ID clinicians provide consultation upon request of the primary team. IDC has been shown to be beneficial for many conditions; however, the impact of IDC for COVID-19 is unknown. Herein, we discuss the potential benefits and pitfalls of automatic IDC for COVID-19 inpatients. Important considerations include the quality of care provided, allocation and optimization of resources, and clinician satisfaction. Finally, we describe how automatic IDC changed throughout the COVID-19 pandemic at a single academic medical center.

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1949. Putting Out Fires: Assessing Burnout within an Infectious Diseases Fellowship at an Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.126 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S58-S59

Author(s):

Leslie-Ann Alexander ◽

Barbra M Blair ◽

Wendy Stead

Keyword(s):

Infectious Diseases ◽

Needs Assessment ◽

Medical Center ◽

Academic Medical Center ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Medical Community ◽

Personal Factors ◽

Academic Medical ◽

Participant Understanding

Abstract Background Burnout, “a psychological syndrome of emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA),” is a well-described problem in the medical community. National surveys report 45% of practicing physicians and 60% of residents and fellows are burnt out. A longitudinal study of medical students and residents reported 45% burnout, as well as career choice regret in 14% of trainees. There are little data about burnout in Infectious Diseases (ID) physicians, including fellows. We sought to measure burnout prevalence in an academic ID Division, identify factors that modified the risk of burnout, and assess knowledge and attitudes about fellow and faculty burnout in the division. Methods The study population included 33 ID physicians (10 fellows, 23 faculties). Level of burnout was assessed via the Maslach Burnout Inventory (MBI), a validated 22-item tool. An additional survey was distributed as a needs assessment to determine participant understanding of “burnout” and “wellness,” ability to recognize burnout in colleagues, attitudes about the scope of the problem, and specific programmatic and personal factors felt to contribute to burnout. Results The MBI was completed by 10 fellows and 16 faculties (76%). A high score in ≥ 1 domain of burnout was reported in 50% of respondents, and 19% received a high score in both EE and DP. Fellows had moderate to high levels of EE (90%) and DP (70%), though all fellows reported at least a moderate sense of PA. The survey needs assessment was completed by 9 fellows and 17 faculties (79%). In a hypothetical case, 100% and 58% of participants correctly identified elements of DP and EE, respectively. Respondents identified several factors contributing to burnout risk, most commonly being lack of schedule autonomy (100%), increasing patient load (96%), and inability to attend teaching conferences (88%). Fellows felt burnt out when seeing ≥ 4 new consults per day and/or carrying a census of 10–11 patients. Conclusion ID fellows at an academic medical center recognize burnout and report levels on par with national data. Fellows and faculty can identify personal and programmatic factors that increase and decrease their risk of burnout. These data can guide programmatic and divisional interventions to improve trainee wellness. Disclosures All Authors: No reported Disclosures.

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2098. Applying Antimicrobial Consumption Metrics to Characterize Inpatient Stewardship Opportunities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1778 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S709-S709

Author(s):

Brian C Bohn ◽

Elizabeth A Neuner ◽

Vasilios Athans ◽

Jill Wesolowski ◽

Thomas G Fraser ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Patient Characteristics ◽

Pharmacist Intervention ◽

Antimicrobial Use ◽

Antimicrobial Consumption ◽

Convenience Sample ◽

Patient Level ◽

Academic Medical ◽

Infectious Diseases Consultation

Abstract Background The purpose of this study was to evaluate antimicrobial consumption metrics as a means for differentiating patient populations and antimicrobial stewardship (AMS) opportunities. Methods This single-center, retrospective, descriptive study included all patients from January 1, 2018 to June 30, 2018 that received ≥1 day of therapy (DOT) of any antimicrobial included in the National Healthcare Safety Network Antimicrobial Use and Resistance (NHSN AUR) module. The cohort was then grouped into 4 quartiles based on DOT (Q1 lowest; Q4 highest). The primary outcome was a Lorenz Curve of DOT per patient over the study period. Secondary outcomes included a comparison of patient characteristics and number/type of AMS-related opportunities present (using a randomized convenience sample of 25 patients per quartile). AMS opportunities were defined as any unnecessary, inappropriate, or suboptimal antimicrobial use with pharmacist intervention or potential for intervention occurring 24 hours after the antimicrobial initiation. Results During the 6 month study period, 24,743 patients accounted for 163,859 days present, and 13,039 (52%) received ≥ 1 DOT. After dividing the population into quartiles of antimicrobial use, median (range) DOT were as follows: Q1 [2 (1–2)], Q2 [4 (3–4)], Q3 [7 (5–10)], Q4 [20 (11–636)] (Figure 1). The top 24% of patients according to antimicrobial use accounted for 74% of total antimicrobial DOT. Patient-level DOT data are displayed by SAAR grouping in Figure 2. In the cohort of 100 patients, differences between quartiles included Infectious diseases consultation in 76% of patients in Q4 compared with 4–24% in other quartiles, ICU admission during hospitalization in 68% in Q4 compared with 28–40% in other quartiles, and any surgical procedure in 88% in Q1 compared with 48–60% in Q2–4. The number of AMS opportunities present were 4 (0.5/1000 DOT) in Q1, 13 (1.6/1000 DOT) in Q2, 28 (1.4/1000 DOT) in Q3, and 86 (0.8/1000 DOT) in Q4. The most common type of AMS opportunity differed by quartile: inappropriate prophylaxis for Q1-3, and de-escalation in Q4. Conclusion Evaluating antimicrobial consumption from a patient-level perspective at a large academic medical center reveals heterogeneity and variable AMS opportunities across quartiles Disclosures All authors: No reported disclosures.

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The Value of Antimicrobial Stewardship Team (AST) in Conjunction with Infectious Diseases Consult in Reducing the 30-day Mortality of Patients with Staphylococcus aureus Bacteremia in a Single Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1277 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S494-S494

Author(s):

Jacqueline Sherbuk ◽

Dayna Mcmanus ◽

Jeffrey Topal ◽

Maricar Malinis

Keyword(s):

Staphylococcus Aureus ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Medical Center ◽

Academic Medical Center ◽

Staphylococcus Aureus Bacteremia ◽

Academic Medical

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The Culture of Carbapenem Overconsumption: Where Does It Begin? Results of a Single-Center Survey

Hospital Pharmacy ◽

10.1177/0018578718775328 ◽

2018 ◽

Vol 54 (3) ◽

pp. 175-179

Author(s):

Bryan T. Mogle ◽

Robert W. Seabury ◽

Zachary Jones ◽

Christopher D. Miller ◽

Jeffrey M. Steele

Keyword(s):

Infectious Diseases ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Prescribing Patterns ◽

Negative Consequences ◽

Local Resistance ◽

Single Center ◽

Academic Medical ◽

Resistance Rates

Purpose: The United States has seen an increased consumption of carbapenem antibiotics in recent years. The increased utilization of these agents has potential negative consequences, including the increasing incidence of carbapenem-resistant Enterobacteriaceae. Reasons for the rise in carbapenem use among providers in acute care hospitals are not well elucidated in literature. The objectives of this study were to identify factors that influence empiric carbapenem use among providers in a single academic medical center, and to assess therapeutic knowledge pertaining to carbapenem use. Methods: A cross-sectional, single-center, 9-item electronic research survey was developed independently and validated by an infectious diseases pharmacist and infectious diseases physician. The survey was distributed to email accounts of providers at a single academic medical center. Demographic data, factors affecting carbapenem prescription, and baseline therapeutic knowledge were assessed. Results: Ninety-five of 416 providers responded to the survey (response rate of 22.8%). Respondents were well distributed across all levels of training with primary roles in internal medicine and surgery. The most important factors influencing empiric carbapenem use were suspected pathogens at the site of infection, drug allergies, history of multidrug resistant organisms, severity of illness, type of infection, and local resistance rates. A recommendation from a pharmacist was selected as the most likely factor for deterring carbapenem use. Misconceptions pertaining to penicillin drug allergy and beta-lactam cross reactivity, knowledge of local resistance rates according to the institutional antibiogram, and comparative efficacy data for carbapenems were apparent across all levels of training. Conclusions: Provider misconceptions regarding several factors appear to contribute to unnecessary use of carbapenems. An opportunity exists for hospital pharmacists to improve the prescribing patterns of carbapenems by correcting provider misconceptions through education.

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