Antimicrobial Stewardship Protecting a Valuable Resource

Size: px
Start display at page:

Download "Antimicrobial Stewardship Protecting a Valuable Resource"

Transcription

1 Antimicrobial Stewardship Protecting a Valuable Resource November 8, 2011 Medical Director Communicable Disease Service NJDHSS Edward.Lifshitz@doh.state.nj.us (609) One can think of the middle of the twentieth century as the end of one of the most important social revolutions in history, the virtual elimination of infectious diseases as a significant factor in social life 1962 Sir Frank MacFarlane Burnet Director of the Walter and Eliza Hall Institute of Medical Research 1960 Nobel Prize co-winner in Physiology or Medicine Unless we act to protect these medical miracles, we could be heading for a post-antibiotic age 2001 Gro Harlem Brundtland WHO Director-General 1

2 Antimicrobial Stewardship Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. Clinical Microbiology Reviews, October 2005, p , Vol. 18, No. 4 Microbes vs Humans Microbes Humans Microbes by factor # on Earth 5 x x 10 9 ~ # cells in a Human 5 x x ~ 5-10 Mass - kg 5 x x ~ 10 8 Generation time 30 min 30 years ~ 5 x 10 5 Time on earth, years 3.5 x x 10 6 ~ 10 3 Data: Schaechter M, et al, Microbiology in the 21 st century: Where Are We and Where Are We Going? Chart: Spellberg B, et al, The Epidemic of Antibiotic-Resistant Infections: A Call to Action for the Medical Community from the Infectious Diseases Society of America Ancient times Honey, lard, lint A Brief History ~ 1550 BC Egyptians Moldy bread ~ 2000 years ago many cultures 2

3 The Magic Bullet 1910 Paul Ehrlich Arsenic based Salvarsan First chemical compound to cure a disease Syphilis Salvarsan Difficult to mix/administer Many side effects Gerhard Domagk Discovered 1935 Sulfonamide Synthetic red dye 1 st commercially available antibacterial Prontosil 3

4 Alexander Fleming Discovered 1928 Penicillin Howard Florey & Ernst Chain Purified and mass produced Introduced 1942 Nature Reviews Microbiology 5, (March 2007) New Antibiotics '83-'87 '88-'92 '93-'97 '98-'02 '03-'07 '08-'11 4

5 Penicillin Armstrong, G. L. et al. JAMA 1999;281:61-66 US Antibiotic Usage Much is unknown Humans ~120 million outpatient & ~ 50 million inpatient Rx/y ~ 3 million lbs/y Animal agriculture ~ 24.6 million lbs/y Source: Mellon, M, et al, Hogging It, Estimates of Antimicrobial Abuse in Livestock Union of Concerned Scientists, January 2001 Nontherapeutic Growth promoters Agricultural Use Mechanism and total effect not clear Majority of antibiotics Therapeutic Treat illness Prophylaxis 5

6 What s the Harm? Resistant organisms shed into environment: Through food chain Direct contact &/or contamination of water and fields Resistant organisms include: Salmonella, Campylobacter, Klebsiella pneumoniaie, Enterococcus faecium, Escherichia coli (ESBL), MRSA Human Use ~ 50% of all antibiotics are unnecessarily or inappropriately prescribed Antibiotic Misuse Not needed Continued longer than necessary Wrong dose Broad spectrum instead of narrow Wrong Ab chosen 6

7 What s the Harm? The Individual Antibiotic use may be associated with: Cost Side effects C. difficle infection Colonization/infection with resistant organism C. difficile Antibiotic exposure is most important risk factor for Clostridium difficile associated disease (CDAD) Up to 85% of patients with CDAD had antibiotic exposure in the 28 days before infection Epidemic strain (NAP-1/BI ) of C. difficile Resistant to flouroquinolones Hospital Acquired C. difficile ~ 1% of inpatients had hospital acquired CDAD ~10% of those with CDAD died ~3 fold increase in hazard of death Arch Intern Med. 2010;170:

8 C. difficle Incidence & Mortality # of CDAD Cases per 100,000 Discharges Annual Mortality Rate per Million Population Year Elixhauser A, et al. Healthcare Cost and Utilization Project: Statistical Brief #50. April Available at: Accessed November 7, Redelings MD, et al. Emerg Infect Dis. 2007;13: Individual Antibiotic Resistance Antibiotic use resistance of urinary/respiratory bacteria to those antibiotics Antibiotics may impact on bacterial resistance for up to 12 months The greater the number or duration of antibiotic courses prescribed in the previous 12 months, the greater the likelihood that resistant bacteria will be isolated from patient Resistance in respiratory tract bacteria and previous antibiotic prescribing Costelloe C et al. BMJ 2010;340:bmj.c by British Medical Journal Publishing Group 8

9 Resistance in urinary tract bacteria (E coli) and antibiotic exposure Costelloe C et al. BMJ 2010;340:bmj.c by British Medical Journal Publishing Group Resistance in respiratory tract streptococci of healthy volunteers and previous antibiotic prescribing Costelloe C et al. BMJ 2010;340:bmj.c by British Medical Journal Publishing Group Cost for Rx 50% inappropriate What s the Harm? The Collective morbidity & mortality from resistant organisms costs from treating these infections We all may need an antibiotic one day 9

10 Increasing Antibiotic Resistance Acinetobacter Gonorrhea Group B streptococcus Extended-spectrum -lactamase (ESBL) GN bacteria Klebsiella, E. Coli Methicillin resistant Staphylococcus aureus (MRSA) Neisseria meningitidis Salmonella Shigella Streptococcus pneumoniae (DRSP) Tuberculosis Vancomycin-resistant Enterococci (VRE) Vancomycin-Intermediate/Resistant Staphylococcus aureus (VISA/VRSA) Viral HIV Non-Bacterial Resistance Influenza Fungus Candida Parasitic Malaria For Example Penicillin Resistance in S. pneumoniae United States vaccine 30 Perecent of isolates Intermediate Fully Resistant Sentinel ABCs : CDC Sentinel Surveillance Network Year : CDC Active Bacterial Core Surveillance (ABCs) /Emerging Infections Program 10

11 Inpatient 50% Unnecessary Pt may appear to have (or possibly have) infection treatable by antibiotics Pneumonia, Urinary tract infection Lack of knowledge: Unnecessary duplication of therapy Overly broad spectrum Lack of time Outpatient 50% Unnecessary Quicker to write Rx than to explain why Diagnostic uncertainty Malpractice Broader spectrum overused Newer=better, Pharm reps Perceived & actual patient expectations Do something What s the Harm? Cultural/Regional Effects 11

12 Over Prescribing Doctors Veterans Less academically inclined Busier not better Poorer diagnosticians 12

13 Outpatient Strategies No magic bullet Small changes with: Guidelines, didactic educational meetings, peer review Outpatient Strategies Bigger changes with: Interactive workshops, educational outreach, MD reminders Multifaceted intervention with education to MDs, patients, general population Delayed prescriptions 13

14 CDC Get Smart Campaign Antimicrobial Stewardship Inpatient Goals Appropriate use of Abs leading to: emergence of resistance patient safety adverse effects including C. dificile Save money ID specialist Antimicrobial Stewardship Team Clinical PharmD with ID training Clinical microbiologist Information system specialist Infection control preventionist Hospital epidemiologist 14

15 Core Strategies Prospective audit with intervention & feedback Academic detailing when order is received Documented significant reductions in use and cost savings Formulary restriction and preauthorization requirement Have stopped C. dificile outbreaks Led to short-term increased susceptibilities among GN pathogens Long-term beneficial impact not established Education Supplemental Strategies Essential element, marginally effective by itself Guidelines and clinical pathways Incorporation of local resistance patterns helps Antimicrobial cycling Insufficient data Antimicrobial order forms Automatic stop orders and MD justification Supplemental Strategies Streamlining or de-escalation of therapy Narrowing Rx based on Cx results Dose optimization Individualize dose for patient/condition Parenteral to oral conversion Earlier changes faster discharge Computer assistance Provides patient-specific data at point of care 15

16 Antimicrobial Stewardship has been shown to decrease C. dificile infections Impact of fluoroquinolone restriction on rates of C. difficle infection HO-CDAD cases/1,000 pd Month and Year 2007 Infect Control Hosp Epidemiol Mar;30(3): Save money. 16

17 Savings of $200,000-$900,000/year Active Management Passive Management Carling et. al. CID,1999;29;1189. And reduce resistance P. aeruginosa susceptibilities before and after implementation of antibiotic restrictions CID 1997;25:230 P<0.01 for all increases 17

18 NJDHSS New Jersey Careful Antibiotic Use Strategies and Education (NJ CAUSE) Multidisciplinary task force Strategic plan to combat antimicrobial resistance 5 Focus areas Surveillance Statewide antibiogram Education NJ CAUSE Conferences, Get Smart, academic detailing Infection Control\Best Practices Determine best practices and disseminate information Laboratory Standardized antimicrobial susceptibility testing Economics Demonstrate cost-savings from stewardship programs Antimicrobial Stewardship Protecting a Valuable Resource November 8, 2011 Medical Director Communicable Disease Service NJDHSS Edward.Lifshitz@doh.state.nj.us (609)

Antibiotic Stewardship in the Hospital Setting

Antibiotic Stewardship in the Hospital Setting Antibiotic Stewardship in the Hospital Setting G. Evans, MD FRCPC Medical Director, Infection Prevention & Control Kingston General Hospital & Hotel Dieu Hospital EOPIC September 26, 2012 Stewardship stew-ard-ship

More information

ANTIBIOTIC STEWARDSHIP

ANTIBIOTIC STEWARDSHIP ANTIBIOTIC STEWARDSHIP S.A. Dehghan Manshadi M.D. Assistant Professor of Infectious Diseases and Tropical Medicine Tehran University of Medical Sciences Issues associated with use of antibiotics were recognized

More information

Antimicrobial stewardship: Quick, don t just do something! Stand there!

Antimicrobial stewardship: Quick, don t just do something! Stand there! Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger

More information

The Rise of Antibiotic Resistance: Is It Too Late?

The Rise of Antibiotic Resistance: Is It Too Late? The Rise of Antibiotic Resistance: Is It Too Late? Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine None DISCLOSURES THE PROBLEM Antibiotic resistance is one of the

More information

3/1/2016. Antibiotics --When Less is More. Most Urgent Threats. Serious Threats

3/1/2016. Antibiotics --When Less is More. Most Urgent Threats. Serious Threats Antibiotics --When Less is More Ralph Gonzales, MD, MSPH Associate Dean, Clinical Innovation School of Medicine VP, Clinical Innovation, UCSF Health Most Urgent Threats Serious Threats Multidrug-Resistant

More information

9/30/2016. Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS

9/30/2016. Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS 1 2 Untoward Effects of Antibiotics Antibiotic resistance Adverse drug events (ADEs) Hypersensitivity/allergy Drug side effects

More information

Antimicrobial stewardship

Antimicrobial stewardship Antimicrobial stewardship Magali Dodemont, Pharm. with the support of Wallonie-Bruxelles International WHY IMPLEMENT ANTIMICROBIAL STEWARDSHIP IN HOSPITALS? Optimization of antimicrobial use To limit the

More information

11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose

11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose Antimicrobial Stewardship Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University

More information

Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly

Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly Wilbur Chen, MD, MS 22-23 March 2017 WHO meeting on Immunization of the Elderly The Problem Increasing consumption

More information

Antimicrobial Stewardship:

Antimicrobial Stewardship: Antimicrobial Stewardship: Inpatient and Outpatient Elements Angela Perhac, PharmD afperhac@carilionclinic.org Disclosure I have no relevant finances to disclose. Objectives Review the core elements of

More information

Physician Rating: ( 23 Votes ) Rate This Article:

Physician Rating: ( 23 Votes ) Rate This Article: From Medscape Infectious Diseases Conquering Antibiotic Overuse An Expert Interview With the CDC Laura A. Stokowski, RN, MS Authors and Disclosures Posted: 11/30/2010 Physician Rating: ( 23 Votes ) Rate

More information

Antibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE

Antibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE Antibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE Crisis: Antibiotic Resistance Success Strategy WWW.optimistic-care.org

More information

Get Smart For Healthcare

Get Smart For Healthcare Get Smart For Healthcare Know When Antibiotics Work Marry Bardin, Quality Improvement Advisor June 9, 2015 Why We Need to Improve In-patient Antibiotic Use Antibiotics are misused in hospitals Antibiotic

More information

Geriatric Mental Health Partnership

Geriatric Mental Health Partnership Geriatric Mental Health Partnership September 8, 2017 First, let s test your knowledge about antibiotics http://www.cdc.gov/getsmart/community/about/quiz.html 2 Get Smart Antibiotics Quiz Antibiotics fight

More information

Updates in Antimicrobial Stewardship

Updates in Antimicrobial Stewardship Updates in Antimicrobial Stewardship Andrew Hunter, Pharm.D., BCPS Infectious Diseases Clinical Pharmacy Specialist Michael E. DeBakey VA Medical Center andrew.hunter@va.gov Disclosures No disclosures

More information

UPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM

UPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM UPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM Diane Rhee, Pharm.D. Associate Professor of Pharmacy Practice Roseman University of Health Sciences Chair, Valley Health

More information

The International Collaborative Conference in Clinical Microbiology & Infectious Diseases

The International Collaborative Conference in Clinical Microbiology & Infectious Diseases The International Collaborative Conference in Clinical Microbiology & Infectious Diseases PLUS: Antimicrobial stewardship in hospitals: Improving outcomes through better education and implementation of

More information

Jump Starting Antimicrobial Stewardship

Jump Starting Antimicrobial Stewardship Jump Starting Antimicrobial Stewardship Amanda C. Hansen, PharmD Pharmacy Operations Manager Carilion Roanoke Memorial Hospital Roanoke, Virginia March 16, 2011 Objectives Discuss guidelines for developing

More information

What bugs are keeping YOU up at night?

What bugs are keeping YOU up at night? What bugs are keeping YOU up at night? Barbara DeBaun, RN, MSN, CIC 26 th Annual Medical Surgical Nursing Conference South San Francisco, CA April 15, 2016 Objectives Describe the top three infectious

More information

Healthcare Facilities and Healthcare Professionals. Public

Healthcare Facilities and Healthcare Professionals. Public Document Title: DOH Guidelines for Antimicrobial Stewardship Programs Document Ref. Number: DOH/ASP/GL/1.0 Version: 1.0 Approval Date: 13/12/2017 Effective Date: 14/12/2017 Document Owner: Applies to:

More information

Antimicrobial Stewardship 101

Antimicrobial Stewardship 101 Antimicrobial Stewardship 101 Betty P. Lee, Pharm.D. Pediatric Infectious Disease/Antimicrobial Stewardship Pharmacist Lucile Packard Children s Hospital Stanford Disclosure I have no actual or potential

More information

Antimicrobial Stewardship. October 2012

Antimicrobial Stewardship. October 2012 Antimicrobial Stewardship October 2012 Rising Antimicrobial Resistance Methicillin resistant staphylococcus aureus (MRSA) Vancomycin resistant enterococci (VRE) MDR and extremely drug resistant (XDR TB)

More information

Optimizing Antimicrobial Stewardship Activities Based on Institutional Resources

Optimizing Antimicrobial Stewardship Activities Based on Institutional Resources Optimizing Antimicrobial Stewardship Activities Based on Institutional Resources Andrew Hunter, PharmD, BCPS Infectious Diseases Clinical Pharmacy Specialist Michael E. DeBakey VA Medical Center Andrew.hunter@va.gov

More information

Collecting and Interpreting Stewardship Data: Breakout Session

Collecting and Interpreting Stewardship Data: Breakout Session Collecting and Interpreting Stewardship Data: Breakout Session Michael S. Calderwood, MD, MPH Regional Hospital Epidemiologist, Dartmouth-Hitchcock Medical Center March 20, 2019 None Disclosures Outline

More information

Antibiotic Stewardship in LTC What does this mean?

Antibiotic Stewardship in LTC What does this mean? Antibiotic Stewardship in LTC What does this mean? Kieran Moore FCFP,FRCPC, Diane Lu CCFP KFLA Public Health Disclosure The findings and conclusions represent those of the presenter and may not necessarily

More information

Antimicrobial Resistance. The Case for Diagnostics to Better Direct Therapy

Antimicrobial Resistance. The Case for Diagnostics to Better Direct Therapy Antimicrobial Resistance The Case for Diagnostics to Better Direct Therapy Objectives Explain the medical significance of antibiotic resistance Assess the medical impact of disease, such as pneumonia and

More information

MDRO s, Stewardship and Beyond. Linda R. Greene RN, MPS, CIC

MDRO s, Stewardship and Beyond. Linda R. Greene RN, MPS, CIC MDRO s, Stewardship and Beyond Linda R. Greene RN, MPS, CIC linda_greene@urmc.rochester.edu Evolving Threat of Antimicrobial Resistance Why are MDROs important? Limited treatment options Associated with:

More information

Mike Apley Kansas State University

Mike Apley Kansas State University Mike Apley Kansas State University 2003 - Daptomycin cyclic lipopeptides 2000 - Linezolid - oxazolidinones 1985 Imipenem - carbapenems 1978 - Norfloxacin - fluoroquinolones 1970 Cephalexin - cephalosporins

More information

Antibiotic Stewardship in the LTC Setting

Antibiotic Stewardship in the LTC Setting Antibiotic Stewardship in the LTC Setting Joe Litsey, Director of Consulting Services Pharm.D., Board Certified Geriatric Pharmacist Thrifty White Pharmacy Objectives Describe the Antibiotic Stewardship

More information

Using Data to Track Antibiotic Use and Outcomes

Using Data to Track Antibiotic Use and Outcomes Using Data to Track Antibiotic Use and Outcomes Michelle Nemec, PharmD Thrifty White Drug Pharmacy Objectives Describe the Antibiotic Stewardship Core Element of tracking and the specific interventions

More information

It s Time to Regulate Antimicrobial Stewardship Standards in Acute Care Settings. Emily Heil, PharmD, BCPS-AQ ID, AAHIVP

It s Time to Regulate Antimicrobial Stewardship Standards in Acute Care Settings. Emily Heil, PharmD, BCPS-AQ ID, AAHIVP It s Time to Regulate Antimicrobial Stewardship Standards in Acute Care Settings Emily Heil, PharmD, BCPS-AQ ID, AAHIVP Conflict of Interest I have no conflicts of interest to disclose related to the content

More information

Impact of Antimicrobial Stewardship Program

Impact of Antimicrobial Stewardship Program Impact of Antimicrobial Stewardship Program Ripal Joshi, Pharm.D. AAHIVP Tampa General Hospital January 28, 2016 Objectives Provide an overview on antimicrobial stewardship programs (ASP) Describe the

More information

ASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies

ASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies ASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies Theresa Jaso, PharmD, BCPS (AQ-ID) Network Clinical Pharmacy Specialist Infectious Diseases Seton Healthcare Family Ascension

More information

Human health impacts of antibiotic use in animal agriculture

Human health impacts of antibiotic use in animal agriculture Human health impacts of antibiotic use in animal agriculture Beliefs, opinions, and evidence Peter Davies BVSc, PhD College of Veterinary Medicine, University of Minnesota, USA Terminology Antibiotic Compound

More information

Commonwealth of Kentucky Antibiotic Stewardship Practice Assessment For Long-Term Care Facilities

Commonwealth of Kentucky Antibiotic Stewardship Practice Assessment For Long-Term Care Facilities Commonwealth of Kentucky Antibiotic Stewardship Practice Assessment For Long-Term Care Facilities Introduction As the problem of antibiotic resistance continues to worsen in all healthcare setting, we

More information

Antimicrobial Stewardship in the Outpatient Setting. ELAINE LADD, PHARMD, ABAAHP, FAARFM OCTOBER 28th, 2016

Antimicrobial Stewardship in the Outpatient Setting. ELAINE LADD, PHARMD, ABAAHP, FAARFM OCTOBER 28th, 2016 Antimicrobial Stewardship in the Outpatient Setting ELAINE LADD, PHARMD, ABAAHP, FAARFM OCTOBER 28th, 2016 Abbreviations AMS - Antimicrobial Stewardship Program OP - Outpatient OPS - Outpatient Setting

More information

Disclosures. Astellas. The Medicines Company. Theravance Biopharma

Disclosures. Astellas. The Medicines Company. Theravance Biopharma Disclosures Astellas The Medicines Company Theravance Biopharma Objectives Define antimicrobial stewardship using nationally accepted criteria Identify strategies to provide antimicrobial stewardship Review

More information

MAGNITUDE OF ANTIMICROBIAL USE. Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges

MAGNITUDE OF ANTIMICROBIAL USE. Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges John A. Jernigan, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control

More information

8/17/2016 ABOUT US REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM

8/17/2016 ABOUT US REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM Mary Moore, MS CIC MT (ASCP) Infection Prevention Coordinator Great River Medical Center, West Burlington REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM ABOUT

More information

Antibiotic Resistance. Antibiotic Resistance: A Growing Concern. Antibiotic resistance is not new 3/21/2011

Antibiotic Resistance. Antibiotic Resistance: A Growing Concern. Antibiotic resistance is not new 3/21/2011 Antibiotic Resistance Antibiotic Resistance: A Growing Concern Judy Ptak RN MSN Infection Prevention Practitioner Dartmouth-Hitchcock Medical Center Lebanon, NH Occurs when a microorganism fails to respond

More information

ANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES

ANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES ANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES 1 Crisis: Antibiotic Resistance Success Strategy 2 OBJECTIVES Discuss

More information

ANTIMICROBIAL STEWARDSHIP: ADVANCING PATIENT CARE BY IMPROVING MEDICATION USE

ANTIMICROBIAL STEWARDSHIP: ADVANCING PATIENT CARE BY IMPROVING MEDICATION USE ANTIMICROBIAL STEWARDSHIP: ADVANCING PATIENT CARE BY IMPROVING MEDICATION USE ANTHONY M. CASAPAO, PHARM.D. ASSISTANT PROFESSOR OF PHARMACY PRACTICE HUSSON UNIVERSITY SCHOOL OF PHARMACY CLINICAL INFECTIOUS

More information

Stewardship tools. Dilip Nathwani Ninewells Hospital and Medical School Dundee, UK

Stewardship tools. Dilip Nathwani Ninewells Hospital and Medical School Dundee, UK Stewardship tools Dilip Nathwani Ninewells Hospital and Medical School Dundee, UK What is Antimicrobial Stewardship (AMS)? Antimicrobial stewardship has been defined as the optimal selection, dosage, and

More information

Objective 1/20/2016. Expanding Antimicrobial Stewardship into the Outpatient Setting. Disclosure Statement of Financial Interest

Objective 1/20/2016. Expanding Antimicrobial Stewardship into the Outpatient Setting. Disclosure Statement of Financial Interest Expanding Antimicrobial Stewardship into the Outpatient Setting Michael E. Klepser, Pharm.D., FCCP Professor Pharmacy Practice Ferris State University College of Pharmacy Disclosure Statement of Financial

More information

Bugs, Drugs, and No More Shoulder Shrugs: The Role for Antimicrobial Stewardship in Long-term Care

Bugs, Drugs, and No More Shoulder Shrugs: The Role for Antimicrobial Stewardship in Long-term Care Bugs, Drugs, and No More Shoulder Shrugs: The Role for Antimicrobial Stewardship in Long-term Care Molly Curran, PharmD, BCPS Clinical Assistant Professor The University of Texas College of Pharmacy Clinical

More information

Antimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD

Antimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Objectives: Outline the overall function of an

More information

Antimicrobial Stewardship

Antimicrobial Stewardship Antimicrobial Stewardship Background Why Antimicrobial Stewardship 30-50% of antibiotic use in hospitals are unnecessary or inappropriate Appropriate antimicrobial use is a medication-safety and patient-safety

More information

Antimicrobial Stewardship in the Hospital Setting

Antimicrobial Stewardship in the Hospital Setting GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 12 Antimicrobial Stewardship in the Hospital Setting Authors Dan Markley, DO, MPH, Amy L. Pakyz, PharmD, PhD, Michael Stevens, MD, MPH Chapter Editor

More information

ANTIBIOTIC STEWARDSHIP. Brian Mayhue, Pharm D, CGP Director of Pharmacy Palm Beach Gardens Medical Center

ANTIBIOTIC STEWARDSHIP. Brian Mayhue, Pharm D, CGP Director of Pharmacy Palm Beach Gardens Medical Center ANTIBIOTIC STEWARDSHIP Brian Mayhue, Pharm D, CGP Director of Pharmacy Palm Beach Gardens Medical Center Antibiotic Resistance It is not difficult to make microbes resistant to penicillin in the laboratory

More information

Ready to Launch: Antimicrobial Stewardship for All!

Ready to Launch: Antimicrobial Stewardship for All! Ready to Launch: Antimicrobial Stewardship for All! Lucas Schulz, PharmD, BCPS AQ ID Clinical Coordinator Infectious Diseases PGY2 Infectious Diseases Residency Program Director Disclosures Consultant

More information

Overview of C. difficile infections. Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases

Overview of C. difficile infections. Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases Overview of C. difficile infections Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases Conflicts of Interest I have no financial conflicts of interest related to this topic and presentation.

More information

03/09/2014. Infection Prevention and Control A Foundation Course. Talk outline

03/09/2014. Infection Prevention and Control A Foundation Course. Talk outline Infection Prevention and Control A Foundation Course 2014 What is healthcare-associated infection (HCAI), antimicrobial resistance (AMR) and multi-drug resistant organisms (MDROs)? Why we should be worried?

More information

Appropriate Antimicrobial Use in California: The Path of Least Resistance

Appropriate Antimicrobial Use in California: The Path of Least Resistance Appropriate Antimicrobial Use in California: The Path of Least Resistance BEACON Fall Exchange November 9, 2011 Kavita K. Trivedi, MD Healthcare Associated Infections Program California Department of Public

More information

Antibiotic Stewardship Beyond Hospital Walls

Antibiotic Stewardship Beyond Hospital Walls Antibiotic Stewardship Beyond Hospital Walls Katie Burenheide Foster, PharmD, MS, BCPS, FCCM Pharmacy Clinical Manager & PGY1 Pharmacy Residency Director OBJECTIVES 1. Review what Antibiotic Stewardship

More information

Antibiotic Stewardship: The Facility Role and Implementation. Tim Cozad, LPN, Lead LTC Health Facilities Surveyor

Antibiotic Stewardship: The Facility Role and Implementation. Tim Cozad, LPN, Lead LTC Health Facilities Surveyor Antibiotic Stewardship: The Facility Role and Implementation Tim Cozad, LPN, Lead LTC Health Facilities Surveyor Phase II CMS Regulatory Changes Current information available includes: New Survey Process

More information

Antibiotic Stewardship Program (ASP) CHRISTUS SETX

Antibiotic Stewardship Program (ASP) CHRISTUS SETX Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:

More information

Antimicrobial Stewardship: Guidelines for its Implementation

Antimicrobial Stewardship: Guidelines for its Implementation Antimicrobial Stewardship: Guidelines for its Implementation Loliet Gonzalez Martinez, Pharm.D. Palmetto General Hospital PGY-1 Pharmacy Resident Disclosure The author of this presentation has nothing

More information

Preventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal

Preventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal Preventing Multi-Drug Resistant Organism (MDRO) Infections For National Patient Safety Goal 07.03.01 2009 Methicillin Resistant Staphlococcus aureus (MRSA) About 3-8% of the population at large is a carrier

More information

6/15/2017 PART 1: THE PROBLEM. Objectives. What is Antimicrobial Resistance? Conflicts of Interest Disclosure Statement

6/15/2017 PART 1: THE PROBLEM. Objectives. What is Antimicrobial Resistance? Conflicts of Interest Disclosure Statement Conflicts of Interest Disclosure Statement Getting a grasp on Antibiotic Use and Resistance: Principles of Antimicrobial Stewardship Speaker has nothing to disclose. Jacob M Kesner, PharmD UNMH PGY-2 Infectious

More information

Antibiotics in the future tense: The Application of Antibiotic Stewardship in Veterinary Medicine. Mike Apley Kansas State University

Antibiotics in the future tense: The Application of Antibiotic Stewardship in Veterinary Medicine. Mike Apley Kansas State University Antibiotics in the future tense: The Application of Antibiotic Stewardship in Veterinary Medicine Mike Apley Kansas State University Changes in Food Animal Antibiotic Use How the uses of antibiotics in

More information

Why Antimicrobial Stewardship?

Why Antimicrobial Stewardship? Antimicrobial Stewardship: Why and How CAPT Arjun Srinivasan, MD Associate Director for Healthcare Associated Infection Prevention Programs Division of Healthcare Quality Promotion Why Antimicrobial Stewardship?

More information

Antimicrobial Stewardship

Antimicrobial Stewardship Antimicrobial Stewardship Report: 11 th August 2016 Issue: As part of ensuring compliance with the National Safety and Quality Health Service Standards (NSQHS), Yea & District Memorial Hospital is required

More information

Understanding the Hospital Antibiogram

Understanding the Hospital Antibiogram Understanding the Hospital Antibiogram Sharon Erdman, PharmD Clinical Professor Purdue University College of Pharmacy Infectious Diseases Clinical Pharmacist Eskenazi Health 5 Understanding the Hospital

More information

Antimicrobial Stewardship-way forward. Dr. Sonal Saxena Professor Lady Hardinge Medical College New Delhi

Antimicrobial Stewardship-way forward. Dr. Sonal Saxena Professor Lady Hardinge Medical College New Delhi Antimicrobial Stewardship-way forward Dr. Sonal Saxena Professor Lady Hardinge Medical College New Delhi Lets save what we have! What is Antibiotic stewardship? Optimal selection, dose and duration of

More information

Epidemiology and Economics of Antibiotic Resistance

Epidemiology and Economics of Antibiotic Resistance Epidemiology and Economics of Antibiotic Resistance Eili Y. Klein February 17, 2016 Health Watch USA Meeting I. The burden of antibiotic resistance is a growing global threat, but hard numbers are lacking

More information

Imagine. Multi-Drug Resistant Superbugs- What s the Big Deal? A World. Without Antibiotics. Where Simple Infections can be Life Threatening

Imagine. Multi-Drug Resistant Superbugs- What s the Big Deal? A World. Without Antibiotics. Where Simple Infections can be Life Threatening Multi-Drug Resistant Superbugs- What s the Big Deal? Toni Biasi, RN MSN MPH CIC Infection Prevention Indiana University Health Imagine A World Without Antibiotics A World Where Simple Infections can be

More information

GUIDELINES EXECUTIVE SUMMARY

GUIDELINES EXECUTIVE SUMMARY GUIDELINES Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship Timothy

More information

5/15/17. Core Elements of Outpatient Antibiotic Stewardship: Implementing Antibiotic Stewardship Into Your Outpatient Practice.

5/15/17. Core Elements of Outpatient Antibiotic Stewardship: Implementing Antibiotic Stewardship Into Your Outpatient Practice. National Center for Emerging and Zoonotic Infectious Diseases Core Elements of Outpatient Antibiotic Stewardship: Implementing Antibiotic Stewardship Into Your Outpatient Practice Melinda Neuhauser, PharmD,

More information

Dr. Charles Onunkwo, Infectious Disease Medicine Erika Ingram, Infectious Disease/Critical Care Clinical Pharmacy Specialist Southeastern Regional

Dr. Charles Onunkwo, Infectious Disease Medicine Erika Ingram, Infectious Disease/Critical Care Clinical Pharmacy Specialist Southeastern Regional Dr. Charles Onunkwo, Infectious Disease Medicine Erika Ingram, Infectious Disease/Critical Care Clinical Pharmacy Specialist Southeastern Regional Medical Center Cancer Treatment Centers of America May

More information

OBJECTIVES. Fast Facts 3/23/2017. Antibiotic Stewardship Beyond Hospital Walls. Antibiotics are a shared resource and becoming a scarce resource.

OBJECTIVES. Fast Facts 3/23/2017. Antibiotic Stewardship Beyond Hospital Walls. Antibiotics are a shared resource and becoming a scarce resource. Antibiotic Stewardship Beyond Hospital Walls Katie Burenheide Foster, PharmD, MS, BCPS, FCCM Pharmacy Clinical Manager & PGY1 Pharmacy Residency Director OBJECTIVES 1. Review what Antibiotic Stewardship

More information

EVIDENCE BASED MEDICINE: ANTIBIOTIC RESISTANCE IN THE ELDERLY CHETHANA KAMATH GERIATRIC MEDICINE WEEK

EVIDENCE BASED MEDICINE: ANTIBIOTIC RESISTANCE IN THE ELDERLY CHETHANA KAMATH GERIATRIC MEDICINE WEEK EVIDENCE BASED MEDICINE: ANTIBIOTIC RESISTANCE IN THE ELDERLY CHETHANA KAMATH GERIATRIC MEDICINE WEEK EPIDEMIOLOGY AND BACKGROUND Every year, more than 2 million people in the United States acquire antibiotic-resistant

More information

Summary of the latest data on antibiotic resistance in the European Union

Summary of the latest data on antibiotic resistance in the European Union Summary of the latest data on antibiotic resistance in the European Union EARS-Net surveillance data November 2017 For most bacteria reported to the European Antimicrobial Resistance Surveillance Network

More information

Antimicrobial Stewardship in the Long Term Care and Outpatient Settings. Carlos Reyes Sacin, MD, AAHIVS

Antimicrobial Stewardship in the Long Term Care and Outpatient Settings. Carlos Reyes Sacin, MD, AAHIVS Antimicrobial Stewardship in the Long Term Care and Outpatient Settings Carlos Reyes Sacin, MD, AAHIVS Disclosure Speaker and consultant in HIV medicine for Gilead and Jansen Pharmaceuticals Objectives

More information

Antimicrobial Stewardship

Antimicrobial Stewardship Antimicrobial Stewardship Preventing the Spread of Antibiotic Resistance and Improving Patient Care (Adapted from the Centers for Disease Control and Prevention) What is Stewardship? Antimicrobial stewardship

More information

Antimicrobial Stewardship Strategy: Antibiograms

Antimicrobial Stewardship Strategy: Antibiograms Antimicrobial Stewardship Strategy: Antibiograms A summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region. Its main functions are to guide

More information

GUIDELINES EXECUTIVE SUMMARY

GUIDELINES EXECUTIVE SUMMARY GUIDELINES Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship Timothy

More information

ANTIBIOTICS IN THE ER:

ANTIBIOTICS IN THE ER: ANTIBIOTICS IN THE ER: EXPLORING THE ROLE OF ANTIMICROBIAL STEWARDSHIP IN THE EMERGENCY DEPARTMENT ANGELINA DAVIS, PHARMD, MS, BCPS (AQ-ID) LIAISON CLINICAL PHARMACIST DUKE ANTIMICROBIAL STEWARDSHIP OUTREACH

More information

MHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative

MHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative MHA/OHA HIIN Antibiotic Stewardship/MDRO Collaborative Place picture here Nov. 14, 2017 Reminders For best sound quality, dial in at 1-800-791-2345 and enter code 11076 Please use the chat box to ask questions!

More information

Selective toxicity. Antimicrobial Drugs. Alexander Fleming 10/17/2016

Selective toxicity. Antimicrobial Drugs. Alexander Fleming 10/17/2016 Selective toxicity Antimicrobial Drugs Chapter 20 BIO 220 Drugs must work inside the host and harm the infective pathogens, but not the host Antibiotics are compounds produced by fungi or bacteria that

More information

Antibiotic stewardship in long term care

Antibiotic stewardship in long term care Antibiotic stewardship in long term care Shira Doron, MD Associate Professor of Medicine Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston, MA Consultant to Massachusetts

More information

3/16/2016. Marguerite A. Erme, DO, MPH Medical Director Summit County Public Health

3/16/2016. Marguerite A. Erme, DO, MPH Medical Director Summit County Public Health Marguerite A. Erme, DO, MPH Medical Director Summit County Public Health By the end of the presentation, the participant will be able to: Describe the history of antibiotic development and antibiotic resistance

More information

Enhancement of Antimicrobial Stewardship with TheraDoc Clinical Decision Support Software

Enhancement of Antimicrobial Stewardship with TheraDoc Clinical Decision Support Software THERADOC WHITE PAPER Enhancement of Antimicrobial Stewardship with TheraDoc Clinical Decision Support Software Jason Pogue, PharmD, BCPS-ID Clinical Pharmacist Specialist, Infectious Diseases Department

More information

Keeping Antibiotics Working: Nursing Leadership in Action

Keeping Antibiotics Working: Nursing Leadership in Action Keeping Antibiotics Working: Nursing Leadership in Action Pat McLaine, DrPH, MPH, RN Robyn Gilden, PhD, RN Department of Family and Community Health Maryland Nurses Association October 2016 US 2 million

More information

Antimicrobial Stewardship Basics Why, What, Who, and How. Philip Chung, PharmD, MS, BCPS ASAP Community Network Pharmacy Coordinator October 12, 2017

Antimicrobial Stewardship Basics Why, What, Who, and How. Philip Chung, PharmD, MS, BCPS ASAP Community Network Pharmacy Coordinator October 12, 2017 Antimicrobial Stewardship Basics Why, What, Who, and How Philip Chung, PharmD, MS, BCPS ASAP Community Network Pharmacy Coordinator October 12, 2017 Objectives List reasons for developing antimicrobial

More information

Antibiotics. Antimicrobial Drugs. Alexander Fleming 10/18/2017

Antibiotics. Antimicrobial Drugs. Alexander Fleming 10/18/2017 Antibiotics Antimicrobial Drugs Chapter 20 BIO 220 Antibiotics are compounds produced by fungi or bacteria that inhibit or kill competing microbial species Antimicrobial drugs must display selective toxicity,

More information

Define evidence based practices for selection and duration of antibiotics to treat suspected or confirmed neonatal sepsis

Define evidence based practices for selection and duration of antibiotics to treat suspected or confirmed neonatal sepsis GLOBAL AIM: Antibiotic Stewardship Perinatal Quality Improvement Teams (PQITs) will share strategies and lessons learned to develop potentially better practices and employ QI methodologies to establish

More information

Antibiotic Stewardship in Human Health- Progress and Opportunities

Antibiotic Stewardship in Human Health- Progress and Opportunities National Center for Emerging and Zoonotic Infectious Diseases Antibiotic Stewardship in Human Health- Progress and Opportunities CAPT Lauri A. Hicks, D.O. Director, Office of Antibiotic Stewardship Division

More information

Responsible use of antibiotics

Responsible use of antibiotics Responsible use of antibiotics Uga Dumpis MD, PhD Department of Infectious Diseases and Infection Control Pauls Stradiņs Clinical University Hospital Challenges in the hospitals Antibiotics are still effective

More information

1/30/ Division of Disease Control and Health Protection. Division of Disease Control and Health Protection

1/30/ Division of Disease Control and Health Protection. Division of Disease Control and Health Protection Surveillance, Outbreaks, and Reportable Diseases, Oh My! Assisted Living Facility, Nursing Home and Surveyor Infection Prevention Training February 2015 A.C. Burke, MA, CIC Health Care-Associated Infection

More information

running head: SUPERBUGS Humphreys 1

running head: SUPERBUGS Humphreys 1 running head: SUPERBUGS Humphreys 1 Superbugs GCH 360 Term Paper Assignment Kelly Humphreys April 30, 2014 SUPERBUGS Humphreys 2 Introduction The World Health Organization (WHO) recognizes antibiotic resistance

More information

United States Outpatient Antibiotic Prescribing and Goal Setting

United States Outpatient Antibiotic Prescribing and Goal Setting National Center for Emerging and Zoonotic Infectious Diseases United States Outpatient Antibiotic Prescribing and Goal Setting Katherine Fleming-Dutra, MD Office of Antibiotic Stewardship Division of Healthcare

More information

Understand the application of Antibiotic Stewardship regulations in LTC. Understand past barriers to antibiotic management concepts

Understand the application of Antibiotic Stewardship regulations in LTC. Understand past barriers to antibiotic management concepts Objectives Understand the application of Antibiotic Stewardship regulations in LTC Understand past barriers to antibiotic management concepts Understand benefits of adoption of antibiotic stewardship regulations

More information

Talk outline. History of resistance. The start of antibiotic resistance: Penicillin. Bacterial evolution vs mankind s ingenuity

Talk outline. History of resistance. The start of antibiotic resistance: Penicillin. Bacterial evolution vs mankind s ingenuity At UN, global leaders commit to act on antimicrobial resistance 21 September 2016 Antibiotic resistance: the need for innovative global and local policy in response to market failure. Dr. Ken Harvey MB

More information

LEARNING OBJECTIVES ANTIMICROBIAL USES AND ABUSES INFECTIOUS DISEASE SCARES

LEARNING OBJECTIVES ANTIMICROBIAL USES AND ABUSES INFECTIOUS DISEASE SCARES LEARNING OBJECTIVES ANTIMICROBIAL USES AND ABUSES Goodbye to the Antibiotic Era? Glenn D. Bedsole, MD, FACP Infectious Disease Consultant 1. Be able to list 6 examples of resistant bacteria that present

More information

Nursing Home Online Training Sessions Session 2: Exploring Antibiotics and Their Role in Fighting Bacterial Infections

Nursing Home Online Training Sessions Session 2: Exploring Antibiotics and Their Role in Fighting Bacterial Infections National Nursing Home Quality Care Collaborative Nursing Home Online Training Sessions Session 2: Exploring Antibiotics and Their Role in Fighting Bacterial Infections Health Services Advisory Group (HSAG)

More information

Potential Conflicts of Interest. Schematic. Reporting AST. Clinically-Oriented AST Reporting & Antimicrobial Stewardship

Potential Conflicts of Interest. Schematic. Reporting AST. Clinically-Oriented AST Reporting & Antimicrobial Stewardship Potential Conflicts of Interest Clinically-Oriented AST Reporting & Antimicrobial Stewardship Hsu Li Yang 27 th September 2013 Research Funding: Pfizer Singapore AstraZeneca Janssen-Cilag Merck, Sharpe

More information

Hot Topics in Antimicrobial Stewardship. Meghan Brett, MD Medical Director, Antimicrobial Stewardship University of New Mexico Hospital

Hot Topics in Antimicrobial Stewardship. Meghan Brett, MD Medical Director, Antimicrobial Stewardship University of New Mexico Hospital Hot Topics in Antimicrobial Stewardship Meghan Brett, MD Medical Director, Antimicrobial Stewardship University of New Mexico Hospital Antimicrobial Stewardship Goals Primary Goal Optimize clinical outcomes

More information

2016/LSIF/FOR/007 Improving Antimicrobial Use and Awareness in Korea

2016/LSIF/FOR/007 Improving Antimicrobial Use and Awareness in Korea 2016/LSIF/FOR/007 Improving Antimicrobial Use and Awareness in Korea Submitted by: Asia Pacific Foundation for Infectious Diseases Policy Forum on Strengthening Surveillance and Laboratory Capacity to

More information

GUIDE TO INFECTION CONTROL IN THE HOSPITAL. Antibiotic Resistance

GUIDE TO INFECTION CONTROL IN THE HOSPITAL. Antibiotic Resistance GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 4: Antibiotic Resistance Author M.P. Stevens, MD, MPH S. Mehtar, MD R.P. Wenzel, MD, MSc Chapter Editor Michelle Doll, MD, MPH Topic Outline Key Issues

More information

Promoting Appropriate Antimicrobial Prescribing in Secondary Care

Promoting Appropriate Antimicrobial Prescribing in Secondary Care Promoting Appropriate Antimicrobial Prescribing in Secondary Care Stuart Brown Healthcare Acquired Infection and Antimicrobial Resistance Project Lead NHS England March 2015 Introduction Background ESPAUR

More information