Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report
|
|
- Ashley Stokes
- 5 years ago
- Views:
Transcription
1 Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report July December 216
2 Table of Contents I. Introduction... 3 II. Executive Summary... 5 III. MCH Antimicrobial Utilization Reports... 7 A. Total MCH Antibiotic DDD and Expenditures... 7 B. Critical Care C. Emergency Department D. Medical Dayward and IV Therapy Area E. Medicine F. Surgery... 3 IV. Clostridium difficile Infection (CDI) Prospective Audit and Feedback V. Antimicrobial Stewardship Pharmacist Interventions VI. Appendix 1 - Villa Caritas (VC) VII. Appendix A. Utilization Reports - Methods B. Glossary of Terms Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 2
3 I. Introduction Antibiotics are among the most commonly prescribed medications in acute care centres (Figure 1), yet can result in unintended patient toxicities, selection of pathogenic organisms such as C. difficile and promotion of antibiotic resistance. Figure 1. MCH Drug Expenditures July - December 216 Antimicrobial expenditures Total drug expenditures 15% 85% Antimicrobial Stewardship is an interdisciplinary activity that promotes the optimization of antibiotic selection, dose, route and duration in order to improve patient clinical outcomes and safety, minimize antibiotic adverse effects and toxicity, decrease the selection of pathogenic organisms and reduce antibiotic resistance rates. An effective Antimicrobial Stewardship Program (ASP) has been demonstrated to achieve the above outcomes and as of 213, has been mandated as a Required Organizational Practice by Accreditation Canada. The Covenant Health Antimicrobial Stewardship Committee (CHASC) was developed in May 213 and has since implemented several initiatives including: 1. Formulary restriction and preauthorization for daptomycin, ertapenem, imipenem, linezolid, meropenem and tigecycline. 2. Prospective audit and feedback of piperacillin-tazobactam and other antimicrobials. 3. Development of a Clostridium difficile Infection (CDI) Preprinted Medication Order Set (PMOS) with prospective audit and feedback. 4. Collation of antibiotic utilization data. 5. Circulation of a Covenant Health Antimicrobial Stewardship e-newsletter (CHASE) quarterly. 6. Wide distribution and posting of formulary guidelines for the carbapenems and piperacillintazobactam to promote guideline concordant use. 7. Development of a Preprinted Medication Order Set for the combined use of cefazolin and probenecid for simple cellulitis in outpatient areas. 8. Prospective audit and feedback of Staphylococcus aureus bacteremia according to evidencebased guidelines. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 3
4 Antibiotic use at Covenant Health acute care sites is collated and examined by CHASC on a quarterly basis in order to: Identify any antibiotic utilization trends or areas in need of intervention on a site and servicespecific basis. Ensure that the use of broad-spectrum antibiotics is guideline concordant. Generate semi-annual reports summarizing antibiotic trends and CHASC recommendations for prescribers as direct feedback on their antibiotic use. Summary of MCH Services included: Critical Care Units (CCU and ICU) Emergency (ED) Medical Dayward and IV Therapy Area (similar to an intravenous therapy clinic) Medicine Family and Internal Medicine, Geriatrics, Emergency Inpatients (ERIP) Surgery Orthopedic, Other (General, Obstetrics & Gynecology, Urology) Antibiotic Utilization Graphs: Antibiotic utilization is provided in three graphical formats: 1. Total drug DDD and expenditures for the hospital 2. Total inpatient drug DDD and expenditures per 1 patient days 3. Total outpatient drug DDD and expenditures per 1 patients or visits Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 4
5 II. Executive Summary Antibiotic utilization data is provided in graphical format from July 213 to December 216. This current semi-annual report describes data for the period of July 1 to December 31, 216 for the following: Guideline concordance rates for the six restricted antibiotics (daptomycin, ertapenem, imipenem, linezolid, meropenem and tigecycline). The restricted antibiotic order form took effect in October 213. prescribing, including indications, guideline concordance rates and rate of streamlining. Audit and feedback on piperacillin-tazobactam use began in March 214. Degree of guideline concordant treatment for C.difficile (CDI) and Preprinted Medication Order Set (PMOS) use which was first introduced in December 213. Overall Antibiotic Use: Overall antibiotic use at MCH has remained stable since July 213. Cephalosporins continue to be the most commonly prescribed antibiotics. Restricted antibiotic use is similar to the previous six month period. use has increased over the last six months and remains elevated since the return of one Internal Medicine unit to the MCH on May 1, 214. Restricted Antibiotics: The carbapenems are the most commonly prescribed restricted antibiotics with the majority of orders deemed guideline concordant. Daptomycin continues to be used in prolonged courses for a few patients in a guideline concordant manner. Linezolid is used in small quantities and there was no use of tigecycline. Compliance with the Restricted Antibiotic Preauthorization Form and Guideline Concordance Rates: For the period of July to December 216, there was an increase in the use of the restricted antibiotics compared to the previous semi-annual report (from 98 to14 orders). The guideline concordance rate remained similar at 88% (previously 87%). Compliance with the restricted antibiotic form decreased slightly from 81% to 79%. Guideline concordant prescribing of ertapenem in Surgery decreased from 8% in the previous semi-annual report to 63%. Audit and Feedback: remains one of the most frequently prescribed antibiotics at MCH and has been targeted for prospective audit and feedback. There was a decrease in guideline concordant prescribing [333/393 (85%)] for the period of July to December 216 compared to the previous six months. Rates of discordant prescribing increased in both the ED (from 13% to 33%) and Medicine units (from 7% to 16%). 184/393 (47%) piperacillin-tazobactam orders were streamlined in 2.2 days on average which is within the de-escalation target of hours. Of the remaining 21 patients, 16 received a full course of piperacillin-tazobactam which was deemed appropriate. The remaining 14 patients did not receive a full course due to: death (26), received empiric therapy until definitive diagnosis (42), escalation to a broader antibiotic (18) or transfer to another facility (18). Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 5
6 C. difficile (CDI) Audit and Feedback: Prospective audit and feedback is performed on all CDI cases to ensure treatment is guideline concordant. The number of CDI cases increased from 56 in the previous semi-annual report to 63 for the period of July to December 216. Of the 63 patients, 92% received initial guideline concordant therapy. This increased to 1% with ASP pharmacist interventions. Additionally, acid suppressive therapy was stopped in five cases by the ASP pharmacist. Use of the CDI PMOS increased from 41% to 52%. Recommendations: Continue to improve rates of compliance in completing the restricted antibiotic preauthorization form. Continue the judicious use of the six restricted antibiotics by ensuring that these broadspectrum antibiotics are only being used for formulary approved indications and are narrowed upon culture availability if possible. MCH Surgery to optimize their ertapenem prescribing by adhering to the following provincial guidelines: 1. Empiric therapy of polymicrobial complicated skin and skin structure infections, including bite wound infections. 2. Therapy of infections due to Enterobacteriaceae producing inducible (AmpC) ß-lactamases or extended-spectrum ß-lactamases (ESBLs) where there is resistance to first line agents and documented susceptibility to ertapenem. 3. Empiric therapy for patients at high risk (e.g. previous ESBL infection, international travel history) of infections due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs). 4. Therapy of community-acquired intra-abdominal infections in patients intolerant or unresponsive to first line therapy (ceftriaxone and metronidazole). Continue guideline concordant prescribing of piperacillin-tazobactam with de-escalation within 48 to 72 hours according to culture availability and the clinical status of the patient. MCH ED and Medicine to optimize their piperacillin-tazobactam prescribing. Orders should comply with the following provincial guidelines for use: 1. Empiric therapy of severe infections including sepsis of unknown source or suspected to be polymicrobial (e.g. intra-abdominal, limb threatening diabetic foot) 2. Alone or in combination, empiric therapy of ventilator-associated pneumonia 3. Empiric therapy in high risk febrile neutropenic patients (oral temperature 38.3 C once or 38 C for 1 hour, absolute neutrophil count <.5 x 1 9 /L) +/- aminoglycoside NB: For monomicrobial infections due to Pseudomonas aeruginosa, options for therapy include ceftazidime, ciprofloxacin, piperacillin (still available), or aminoglycosides, according to susceptibility. Work with IPC to improve compliance with the use of the CDI PMOS to ensure optimal CDI management. Please refer to the service specific section of this report for further details regarding service specific prescribing and Antimicrobial Stewardship recommendations. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 6
7 III. MCH Antimicrobial Utilization Reports A. Total MCH Antibiotic DDD and Expenditures July 213 December 216 (Figure 2) Parenteral antibiotics account for the majority of the utilization and expenditures hospital-wide. Overall antibiotic use has remained stable for the period July to December 216. Cephalosporins were the most commonly ordered IV antibiotic and carbapenems, cefazolin, and piperacillintazobactam accounted for the majority of costs. Ertapenem is the most frequently prescribed restricted antibiotic. Daptomycin is occasionally being used in orthopedic patients intolerant of vancomycin. Compliance with the restricted antibiotic preauthorization form decreased slightly from 81% to 79% (81/14). Overall, the restricted antibiotics were prescribed in a guideline concordant manner in 88% (92/14) of cases (Table 1). Since the implementation of preauthorization and audit and feedback of the six restricted antibiotics, the number of restricted antibiotic orders has decreased along with the number of discordant orders (Figure 3). use increased for the period of July to December 216 (Figure 2). The most common clinical indications for use were intra-abdominal infections, sepsis NYD and pneumonia (Figure 4). There were 393 orders for the period of July to December 216 with a guideline concordance rate of 85% (333/393) (Table 2). Of these, 47% (184/393) of piperacillin-tazobactam orders were de-escalated, primarily by the attending team, in an average of 2.2 days (Table 3). In the remaining patients (21/393), 16 completed a guideline concordant treatment course with piperacillin-tazobactam. The remaining 14 patients did not complete a full course of piperacillintazobactam for various reasons such as death or transfer to another facility. The most common discordant use of piperacillin-tazobactam was for community acquired pneumonia (CAP) or community acquired aspiration pneumonia with 31 orders (Table 3). Recommendations: Continue to improve rates of completion of the restricted antibiotic preauthorization form. Continue to use the six restricted antibiotics judiciously in a guideline concordant manner. Ensure piperacillin-tazobactam is being prescribed in a guideline concordant manner. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 7
8 Figure 2. Total MCH Antimicrobial Usage and Expenditures 25 MCH Total DDD * Oral Parenteral $25 MCH Total Expenditures $2 $15 $1 $5 $ * Oral Parenteral * MCH DDD Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. *Return of Internal Medicine Unit to MCH Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 8
9 $14 $12 $1 $8 $6 $4 $2 $ * MCH Expenditures Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin * MCH DDD Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline $6 $5 $4 $3 $2 $1 $ * MCH Expenditures Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. *Return of Internal Medicine Unit to MCH Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 9
10 Table 1. Total MCH Compliance with Preauthorization Form and Guideline Concordance Rates Service Antibiotic Number of Orders July to December 216 Guideline Concordant Form Compliance Recommendations (Number and percent accepted) ED Ertapenem 2 1 (5%) 2 (1%) Total 2 1 (5%) 2 (1%) HPT Daptomycin 1 1 (1%) 1 (1%) Total 1 1 (1%) 1 (1%) ICU Ertapenem 3 3 (1%) 3 (1%) Imipenem 5 5 (1%) 5 (1%) Linezolid 2 2 (1%) 2 (1%) 1 (1%) Meropenem 3 3 (1%) 2 (67%) Total (1%) 12 (92%) 1 (1%) Medical Dayward and IV Therapy Area Daptomycin 2 2 (1%) 2 (1%) Ertapenem 9 8 (89%) 4 (44%) 1 (1%) Total 11 1 (91%) 6 (55%) 1 (1%) Medicine Daptomycin 4 4 (1%) 3 (75%) Ertapenem 12 1 (83%) 9 (75%) 3 (1%) Imipenem 2 19 (95%) 16 (8%) 4 (75%) Linezolid 1 1 (1%) 1 (1%) Meropenem 4 4 (1%) 4 (1%) 2 (1%) Total (93%) 33 (8%) 9 (89%) Surgery Daptomycin 7 7 (1%) 7 (1%) 1 (1%) Ertapenem 16 1 (63%) 1 (63%) 3 (1%) Imipenem 8 8 (1%) 7 (88%) Meropenem 5 4 (8%) 3 (6%) 2 (1%) Total (81%) 27 (75%) 6 (1%) Grand Total (88%) 81 (79%) 16 (94%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 1
11 Figure 3. MCH Restricted Antibiotic Orders April 213 to December 216 MCH Restricted Antibiotic Orders, Guideline Concordance and Form Compliance Restricted Antibiotic Orders Guideline Concordant Orders Forms Completed Form implemented Oct 213 Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
12 Figure 4. MCH Orders by Service July to December MCH Piperacillin-Tazobactam Orders Bacteremia Discordant Febrile Neutropenia Genital HEENT IAI Osteomyelitis Pneumonia Prosthetic joint Sepsis NYD SSTI UTI Table 2. MCH Orders by Service July to December 216 Prescribing Prosthetic Sepsis Bacteremia FN Genital HEENT IAI OM PNA SSTI UTI Discordant* Total Service Joint NYD Critical Care ED Infectious Diseases Medicine Family Medicine Internal Psychiatry 1 1 Surgery Orthopedics Surgery Other Wound Care 1 1 Total *Discordant: Bacteremia (1), Genital (1), HEENT (2), IAI (2), Native Joint (3), Pneumonia (31), Sepsis NYD (5), SSTI (1), UTI (5) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
13 Table 3. MCH Orders Streamlined by Indication July to December 216 Clinical Number of Discordant Streamlined Indication Piperacillintazobactam Orders* Initiated by: Average # of days Orders ASP Attending team Bacteremia Febrile Neutropenia Genital HEENT Intraabdominal infection Native Joint Osteomyelitis Pneumonia Prosthetic Joint Sepsis NYD SSTI UTI Total * The majority of patients received an average of 2.2 days of therapy before discontinuation or streamlining. Many patients only received one dose. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
14 B. Critical Care Antibiotic Utilization (Figure 5) The utilization data per 1 patient days is provided for the Cardiac Care Unit (CCU) and Intensive Care Unit (ICU) combined. The DDD per 1 patient days and expenditures have remained stable over the last year. The most common antibiotics used are the cephalosporins followed by piperacillin-tazobactam. There were 13 orders for restricted antibiotics and all were deemed guideline concordant (Table 4). Compliance with the restricted antibiotic preauthorization form has improved greatly from 7% to 1% (Table 4). use has decreased in the last six months and 5/52 (96%) orders were guideline concordant (Table 5). The two discordant orders were stopped after one dose. The most common guideline concordant indications for use were sepsis NYD, pneumonia, and intra-abdominal infections (Table 2). Recommendations: The six restricted antibiotics and piperacillin-tazobactam are primarily prescribed in a guideline concordant manner in the MCH Critical Care areas with excellent form completion rates. No further recommendations for improvement are required at this point in time. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
15 Figure 5. MCH Critical Care* Antimicrobial Usage and Expenditures per 1 Patient Days MCH Total Critical Care DDD/1 Patient Days Oral Parenteral $16 $14 $12 $1 $8 $6 $4 $2 $ MCH Total Critical Care Expenditures/1 Patient Days Oral Parenteral MCH Critical Care DDD/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin *CCU and ICU combined DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
16 $8 $7 $6 $5 $4 $3 $2 $1 $ MCH Critical Care Expenditures/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin MCH Critical Care DDD/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline $4 $35 $3 $25 $2 $15 $1 $5 $ MCH Critical Care Expenditures/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Piperacillintazobactam Tigecycline *CCU and ICU combined DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
17 Table 4. MCH Critical Care Compliance with Preauthorization Form and Guideline Concordance Rates Antibiotic Number of Orders July to December 216 Guideline Concordant Form Compliance Recommendations (Number and percent accepted) Ertapenem 3 3 (1%) 3 (1%) Imipenem 5 5 (1%) 5 (1%) Linezolid 2 2 (1%) 2 (1%) 1 (1%) Meropenem 3 3 (1%) 3 (1%) Total (1%) 13 (1%) Table 5. MCH Critical Care Order Review July to December 216 Number of Orders Guideline Concordant 52 5 (96%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
18 C. Emergency Department (ED) Antibiotic Utilization (Figure 6) Drug utilization data was recorded as ED prescribed if the patient resided in the ED and was not admitted as an inpatient at the time of dispensing. Once accepted by an inpatient team, the drug was thereafter recorded as prescribed by the admitting service. There been a steady increase in overall antibiotic use and expenditures since April 216, primarily mediated by an increase in cephalosporin use. Oral antibiotics were ordered more frequently than parenteral although parenteral antibiotics were responsible for the majority of expenditures. The most commonly ordered antibiotics were the cephalosporins and fluoroquinolones. Use of the six restricted antibiotics has been low from July 213 to December 216. Over the last six months, there were two orders for ertapenem, one of which was guideline discordant (Table 6). use increased from 38 orders in the previous semi-annual report to 48 orders from July to December 216. Guideline concordance decreased from 87% to 67% (Table 7). Approximately half of the discordant orders were prescribed for respiratory conditions not meeting criteria for piperacillin-tazobactam use. The most frequent indications of use for piperacillintazobactam were sepsis NYD and intra-abdominal infections (Table 2). Recommendations: Ertapenem is not necessary in the context of a penicillin allergy and in fact, has a higher crossreactivity rate to penicillin than the third generation cephalosporins. Ensure ertapenem is prescribed in a guideline concordant manner according to the provincial guidelines below: Ertapenem: 1. Empiric therapy of polymicrobial complicated skin and skin structure infections, including bite wound infections. 2. Therapy of infections due to Enterobacteriaceae producing inducible (AmpC) ß-lactamases or extended-spectrum ß-lactamases (ESBLs) where there is resistance to first line agents and documented susceptibility to ertapenem. 3. Empiric therapy for patients at high risk (e.g. previous ESBL infection, international travel history) of infections due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs). 4. Therapy of community-acquired intra-abdominal infections in patients intolerant or unresponsive to first line therapy (ceftriaxone and metronidazole). The rate of discordant piperacillin-tazobactam orders from the MCH ED has increased from 13% to 33% and needs to be improved upon. Please refer to the accompanying table listing the alternatives to piperacillin-tazobactam in those instances where it was ordered in a discordant manner. Of note, piperacillin-tazobactam is excessively broad for community acquired pneumonia where ceftriaxone/azithromycin or levofloxacin should suffice. Please ensure piperacillin-tazobactam is prescribed in a guideline concordant manner according to the provincial guidelines below: 1. Empiric therapy of severe infections including sepsis of unknown source or suspected to be polymicrobial (e.g. intra-abdominal, limb threatening diabetic foot) 2. Alone or in combination, empiric therapy of ventilator-associated pneumonia 3. Empiric therapy in high risk febrile neutropenic patients (oral temperature 38.3 C once or 38 C for 1 hour, absolute neutrophil count <.5 x 1 9 /L) +/- aminoglycoside NB: For monomicrobial infections due to Pseudomonas aeruginosa, options for therapy include ceftazidime, ciprofloxacin, piperacillin (still available), or aminoglycosides, according to susceptibility. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
19 Figure 6. MCH ED* Antimicrobial Usage and Expenditures per 1 Patient Visits MCH Total ED DDD/1 Patient Visits Oral Parenteral $7 $6 $5 $4 $3 $2 $1 $ MCH Total ED Expenditures/1 Patient Visits Oral Parenteral MCH ED DDD/1 Patient Visits Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin *Does not include ERIP DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
20 $45 $4 $35 $3 $25 $2 $15 $1 $5 $ MCH ED Expenditures/1 Patient Visits Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin MCH ED DDD/1 Patient Visits Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline $14 $12 $1 $8 $6 $4 $2 $ MCH ED Expenditures/1 Patient Visits Daptomycin Ertapenem Imipenem Linezolid Meropenem Piperacillintazobactam Tigecycline *Does not include ERIP DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 2
21 Table 6. MCH ED Compliance with Preauthorization Form and Guideline Concordance Rates Antibiotic Number of Orders July to December 216 Guideline Form Concordant Compliance Ertapenem 2 1 (5%) 2 (1%) Total 2 1 (5%) 2 (1%) Recommendations (Number and Percent Accepted) Table 7. ED Order Review July to December 216 Number of Orders Guideline Concordant (67%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
22 D. Medical Dayward and IV Therapy Area Antibiotic Utilization (Figure 7) Overall antibiotic use has remained stable in the past six months. As patient volumes are low relative to inpatient wards, overall antibiotic use is affected by type of patients attending and their duration of therapy. The most frequently prescribed antibiotics were cefazolin and the third generation cephalosporins. Daptomycin use increased in the last quarter and ertapenem use has remained stable over the past year. There were 11 orders for restricted antibiotics and ten were deemed guideline concordant (Table 8). Completion of the restricted antibiotic preauthorization form had improved in the previous semi-annual report but has decreased again from 9% to 55% (Table 8). use has been minimal with only one order (discordant) in the last six months (Table 9). Recommendations: Improve compliance with completion of the restricted antibiotic form in order to facilitate accurate data collection and feedback to stakeholders. The restricted antibiotics are primarily prescribed in a guideline concordant manner. No further recommendations are required at this time. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
23 Figure 7. MCH Medical Dayward and IV Therapy Area Antimicrobial Usage and Expenditures per 1 Patients MCH Total IV Therapy Area DDD/1 Patients Oral Parenteral $18 $16 $14 $12 $1 $8 $6 $4 $2 $ MCH Total IV Therapy Area Expenditures/1 Patients Oral Parenteral MCH IV Therapy Area DDD/1 Patients Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
24 MCH IV Therapy Area Expenditures/1 Patients $12 $1 $8 $6 $4 $2 $ Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones MCH IV Therapy Area DDD/1 Patients Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline MCH IV Therapy Area Expenditures/1 Patients $14 $12 $1 $8 $6 $4 $2 $ Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
25 Table 8. MCH Medical Dayward and IV Therapy Area Compliance with Preauthorization Form and Guideline Concordance Rates Antibiotic Number of Orders July to December 216 Guideline Concordant Form Compliance Recommendations (Number and percent accepted) Daptomycin 2 2 (1%) 2 (1%) Ertapenem 9 8 (89%) 4 (44%) 1 (1%) Total 11 1 (91%) 6 (55%) 1 (1%) Table 9. MCH Medical Dayward and IV Therapy Area Order Review July to December 216 Program Number of Orders Guideline Concordant Medicine Family 1 (%) Total 1 (%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
26 E. Medicine Antibiotic Utilization (Figure 8) Medicine applies to Internal Medicine, Family Medicine (cannot be separated due to shared inpatient units), ED inpatients and Geriatrics. An Internal Medicine unit was temporarily relocated to the Royal Alexandra Hospital on May 3, 213 and returned to the MCH on May 1, 214. Data from May 1, 214 forward includes this unit. Overall, DDD and expenditures per 1 patient days have decreased in the July to December 216 period. Cephalosporins and fluoroquinolones were the most commonly prescribed antibiotics. Use of piperacillin-tazobactam and the restricted antibiotics has remained stable since October 215, with a recent decline in piperacillin-tazobactam use. The restricted antibiotics were used in a guideline concordant manner for 93% of the orders (Table 1). This rate is similar to the previous semi-annual report (91%). Compliance with completion of the restricted antibiotic preauthorization form has declined from 89% to 8% (Table 1). The largest proportion of piperacillin-tazobactam orders in MCH are from Internal Medicine prescribers. The guideline concordance rates decreased from 93% to 84% (Table 11). Sepsis NYD and hospital acquired pneumonia were the most common indications for use (Table 2). Prescribing of piperacillin-tazobactam for CAP and aspiration pneumonia continues to account for the majority of discordant orders. Recommendations: Improve compliance with completion of the restricted antibiotic form in order to facilitate accurate data collection and feedback to stakeholders. There has been an increase in the number of guideline discordant piperacillin-tazobactam orders for CAP and aspiration pneumonia. Ensure piperacillin-tazobactam is prescribed in a guideline concordant manner according to the provincial guidelines below: 1. Empiric therapy of severe infections including sepsis of unknown source or suspected to be polymicrobial (e.g. intra-abdominal, limb threatening diabetic foot) 2. Alone or in combination, empiric therapy of ventilator-associated pneumonia 3. Empiric therapy in high risk febrile neutropenic patients (oral temperature 38.3 C once or 38 C for 1 hour, absolute neutrophil count <.5 x 1 9 /L) +/- aminoglycoside NB: For monomicrobial infections due to Pseudomonas aeruginosa, options for therapy include ceftazidime, ciprofloxacin, piperacillin (still available), or aminoglycosides, according to susceptibility. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
27 Figure 8. MCH Medicine # Antimicrobial Usage and Expenditures per 1 Patient Days * MCH Total Medicine DDD/1 Patient Days Oral Parenteral $5 $45 $4 $35 $3 $25 $2 $15 $1 $5 $ * MCH Total Medicine Expenditures/1 Patient Days Oral Parenteral * MCH Medicine DDD/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin # Medicine and ERIP; * Return of Internal Medicine Unit to MCH. DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
28 $3 $25 $2 $15 $1 $5 $ * MCH Medicine Expenditures/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin * MCH Medicine DDD/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline $1 $9 $8 $7 $6 $5 $4 $3 $2 $1 $ * MCH Medicine Expenditures/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline # Medicine and ERIP; * Return of Internal Medicine Unit to MCH DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
29 Table 1. MCH Medicine Compliance with Preauthorization Form and Guideline Concordance Rates Antibiotic Number of Orders July to December 216 Guideline Concordant Form Compliance Recommendations (Number and percent accepted) Daptomycin 4 4 (1%) 3 (75%) Ertapenem 12 1 (83%) 9 (75%) 3 (1%) Imipenem 2 19 (95%) 16 (8%) 4 (75%) Linezolid 1 1 (1%) 1 (1%) Meropenem 4 4 (1%) 4 (1%) 2 (1%) Total (93%) 33 (8%) 9 (89%) Table 11. MCH Medicine Order Review July to December 216 Program Number of Orders Guideline Concordant Medicine Family (92%) Medicine Internal (8%) Total (84%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
30 F. Surgery Antibiotic Utilization (Figure 9) Surgical data incorporates general surgery, obstetrics and gynecology, orthopedics and urology. Overall antibiotic use remains stable since July 213. Cefazolin accounts for the majority of parenteral antibiotics. Of the restricted antibiotics, there was a decrease in ertapenem use and an increase in daptomycin use. Since the previous semi-annual report, the guideline concordance rate has remained stable at 81%. Completion of the restricted antibiotic preauthorization form increased from 68% in the previous six months to 75% and needs to be improved upon (Table 12). There was a slight improvement in meropenem guideline concordance (71% to 8%) however, concordance for ertapenem decreased from 8% to 63%. use has fluctuated over the July to December 216 period with a guideline concordance rate of 9% (Table 13). The most common indications for use were intra-abdominal infections (Table 2). Recommendations: Improve compliance with completion of the restricted antibiotic preauthorization form to ensure more accurate data collection and timely feedback for prescribers. Ensure the carbapenems are prescribed in a guideline concordant manner according to the provincial guidelines below: Ertapenem: 5. Empiric therapy of polymicrobial complicated skin and skin structure infections, including bite wound infections. 6. Therapy of infections due to Enterobacteriaceae producing inducible (AmpC) ß-lactamases or extended-spectrum ß-lactamases (ESBLs) where there is resistance to first line agents and documented susceptibility to ertapenem. 7. Empiric therapy for patients at high risk (e.g. previous ESBL infection, international travel history) of infections due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs). 8. Therapy of community-acquired intra-abdominal infections in patients intolerant or unresponsive to first line therapy (ceftriaxone and metronidazole). Imipenem + Meropenem: Guidelines listed apply to both drugs unless otherwise indicated. 1. Therapy of severe infections involving Gram negative organisms in patients who are intolerant of, or unresponsive to, or whose isolates are suspected or documented to be resistant (e.g. ESBL, inducible (AmpC) ß-lactamases) to, first line agents and piperacillin-tazobactam (imipenem preferred if documented susceptibility) 2. Therapy of severe suspected or documented polymicrobial infections in patients who are intolerant of, or unresponsive to, or whose isolates are suspected or documented to be resistant to, first line agents and piperacillin-tazobactam (imipenem preferred if documented susceptibility) 3. Therapy of infections involving multi-drug resistant Pseudomonas aeruginosa where there is documented susceptibility to the carbapenem (cannot assume meropenem susceptibility from imipenem susceptibility and vice versa). 4. Empiric therapy in high risk febrile neutropenic patients +/- aminoglycoside (imipenem preferred if documented susceptibility). 5. Empiric therapy of post-traumatic/post-neurosurgical meningitis in combination with vancomycin. (MEROPENEM) 6. Alternative to ceftazidime for therapy of central nervous system (CNS) infections due to Pseudomonas aeruginosa. (MEROPENEM) 7. As part of combination therapy of infections with Nocardia spp or nontuberculous Mycobacteria spp. (IMIPENEM) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 3
31 Figure 9. MCH Surgery Antimicrobial Usage and Expenditures per 1 Patient Days MCH Total Surgery DDD/1 Patient Days Ortho Surgery - Other $14 $12 $1 $8 $6 $4 $2 $ MCH Total Surgery Expenditures/1 Patient Days Ortho Surgery - Other MCH Surgery DDD/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
32 $7 $6 $5 $4 $3 $2 $1 $ MCH Surgery Expenditures/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin MCH Surgery DDD/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline $3 $25 $2 $15 $1 $5 $ MCH Surgery Expenditures/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
33 Table 12. MCH Surgery Compliance with Preauthorization Form and Guideline Concordance Rates Antibiotic Number of Orders July to December 216 Guideline Concordant Form Compliance Recommendations (Number and percent accepted) Daptomycin 7 7 (1%) 7 (1%) 1 (1%) Ertapenem 16 1 (63%) 1 (63%) 3 (1%) Imipenem 8 8 (1%) 7 (88%) Meropenem 5 4 (8%) 3 (6%) 2 (1%) Total (81%) 27 (75%) 6 (1%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
34 Table 13. MCH Surgery Order Review July to December 216 Program Number of Orders Guideline Concordant Surgery General, Obstetrics, (95%) Urology Surgery Orthopedics (82%) Total (9%) Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
35 IV. Clostridium difficile Infection (CDI) Prospective Audit and Feedback The Antimicrobial Stewardship pharmacist performs an audit on all CDI patients to ensure guideline concordant treatment is initiated, to encourage the use of the CDI Preprinted Medication Order Set (PMOS) and to optimize CDI management as necessary. Compared to the previous six months, the number of chart audits performed for the period of July to December increased from 56 to 63 (Table 14). CDI guideline concordant treatment was initiated in 92% of patients (58/63) and this increased to 1% following interventions made by the Antimicrobial Stewardship pharmacist. Additional interventions included optimizing treatment in 13 cases, altering therapy duration in four cases and discontinuing acid suppressive therapy in five. Use of the CDI PMOS upon initial prescribing has continued to increase from 41% during the period of January to June 216 to 52% (33/63) at present. Improvements in this rate will likely achieve better initial guideline concordant treatment and would trigger the assessment of other offending therapies. There were two deaths attributable to CDI for the period July to December 216. Figure 1 and Figure 11 display the rate of CDI PMOS utilization, CDI treatment guideline concordance rate and the association with CDI rate (per 1, patient days) or attributable mortality. Month Number of cases Table 14. MCH C. difficile Infection Audits CDI Attributable Mortality* July to December 216 Guideline Concordant Treatment CDI PMOS Utilized Alter CDI Treatment Pharmacy Interventions Alter CDI Treatment Duration Discontinue acid suppressive therapy July August September October 2 2 November December Total (92%) 33 (52%) *Accurate at the time of this report but is subject to change due to ongoing IPC surveillance. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
36 Number of CDI Attributable Deaths Guideline Concordnce & PMOS Utilization Rate CDI Rate/1 Patient Days Guideline Concordnce & PMOS Utilization Rate Figure 1. MCH CDI Concordance, PMOS Use and CDI Rate MCH CDI Concordance and Rate CDI Rate PPCO Implemented Dec 213 Guideline Concordant Treatment PPCO Utilization Figure 11. MCH CDI Treatment Concordance, PMOS Use and Mortality MCH CDI Concordance and Mortality CDI Attributable Mortality Guideline Concordant Treatment PPCO Utilization PPCO Implemented Dec 213 Recommendations: CHASC to continue to work with IPC to ensure guideline concordant management of CDI and to increase the use of the CDI PMOS as one effective strategy. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
37 V. Antimicrobial Stewardship Pharmacist Interventions As part of the audit and feedback process of the restricted antibiotics, piperacillin-tazobactam and CDIs, the Antimicrobial Stewardship pharmacist provides recommendations to optimize patient care. Figure 12 highlights the quantity, category and indication of Antimicrobial Stewardship interventions for the period of July to December 216. The attending team accepted 93% (89/96) of the recommendations provided. Figure 12. MCH Antimicrobial Stewardship Pharmacist Interventions Accepted July to December Bacteremia CDI 8 Genital IAI 6 Osteomyelitis Pneumonia 4 prosthetic joint 2 Sepsis NYD SSTI Antimicrobial therapy unnecessary Dose optimization duration of therapy optimized Equivalent efficacy & decreased cost Medication Spectrum of discontinued antimicrobial agent UTI Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
38 VI. Appendix 1 - Villa Caritas (VC) Total VC Antibiotic DDD and Expenditures July 213 December 216 (Figure 1) Antibiotic utilization at Villa Caritas steadily decreased for the period of July to December 216 compared to the previous six month period (Figure 1). There was minimal use of all antibiotic classes including piperacillin-tazobactam. A presentation highlighting Antimicrobial Stewardship initiatives and site specific antibiotic utilization was delivered to VC medical staff in November 216. There was no use of the restricted antibiotics for the period of July to December 216. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
39 Figure 1. Villa Caritas Antimicrobial Usage and Expenditures per 1 Patient Days VC Usage DDD/1 Patient Days Oral Parenteral $4 $35 $3 $25 $2 $15 $1 $5 $ VC Expenditures/1 Patient Days Oral Parenteral VC DDD/1 Patient Days Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
40 VC Expenditures/1 Patient Days $25 $2 $15 $1 $5 $ Carbapenems Cefazolin Cephalosporins 3rd generation Clindamycin Fluoroquinolones Vancomycin VC DDD/1 Patient Days Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline VC Expenditures/1 Patient Days $14 $12 $1 $8 $6 $4 $2 $ Daptomycin Ertapenem Imipenem Linezolid Meropenem Tigecycline DDD = Defined daily dose. Assumed average maintenance dose per day for a drug used for its main indication in adults. Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December 216 4
41 VII. Appendix 2 A. Utilization Reports - Methods Data on antibiotic use is extracted directly from BDM (pharmacy computer system). Clinical information acquired from the antibiotic preauthorization form and/or prospective audit and feedback is compared to the provincial formulary recommendations to determine guideline concordance. Drug utilization data is provided in both DDD (Defined Daily Dose) and expenditures. DDD is a World Health Organization measure of drug consumption. The definition is the assumed average maintenance dose per day for a drug used for its main indication in adults. It relates all drug use to a standardized measure which is equivalent to one day s worth. DDD allows for comparing antibiotic use across different classes despite differences in potency and dosing. Denominator Data DDDs are now provided over the denominator of actual patient days. Incorporating denominator data takes into account changes in utilization that may be due to fluctuations in patient volumes over time. C. difficile hospital rates and mortality data are obtained from Infection Prevention and Control. Denominator Data - Inpatient Areas Patient day denominator data is provided by Analytics [Data Integration, Measurement and Reporting (DIMR)]. It is a summary of the number of patient days at the site by unit and includes emergency admitted patients but excludes emergency non-admitted patients and patients less than one year of age. Patient days are calculated as follows: Emergency department inpatient days are counted from the time of decision to admit until the ED departure for patients admitted to an inpatient bed. Inpatient days are a daily census count. Patients admitted and discharged on the same day are counted as one day and the day of admission is counted but the day of discharge/death is not. The data is provided quarterly and is the same data that is used by Infection Prevention and Control (IPC) for monitoring C. difficile rates. Patient day data has been integrated into the utilization data to obtain DDDs and expenditures per 1 patient days. Denominator Data Outpatient Areas Patient visit denominator data for the Emergency Department is provided by Data and Decision Support using the Power Abstract Database. Emergency visits include patients discharged home, transfers to other clinics or facilities and deaths. It excludes patients left without being seen (LWBS), patients left against medical advice (LAMA) and inpatient admissions. MCH Medical Dayward and IV Therapy Area unique patient numbers are provided by Alberta Health Services Regional Activity and Costing. Patients are counted only once regardless of how many visits the patient makes to the clinic. Outpatient denominator data has been integrated into the utilization data to obtain DDDs and expenditures per 1 patients (Medical Dayward) or visits (ED). Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
42 B. Glossary of Terms ASP. Antimicrobial Stewardship Program CAP.Community Acquired Pneumonia CCU.... Coronary Care Unit CDI... Clostridium difficile Infection CHASC Covenant Health Antimicrobial Stewardship Committee CHASE...Covenant Health Antimicrobial Stewardship e-newsletter DDD....Defined Daily Dose ED...Emergency Department ERIP...Emergency Inpatients ESBL...Extended Spectrum Beta-Lactamase FN.. Febrile Neutropenia HPT.....Home Parenteral Therapy IAI.. Intra-abdominal infection ICU..Intensive Care Unit ID....Infectious Diseases IPC Infection Prevention and Control L & D.Labour and Delivery Unit MCH......Misericordia Community Hospital MDR.....Multi-drug Resistant MSSA.... Methacillin Sensitive Staphylococcus Aureus NB.. Nota bena or Important, Note well NYD...Not Yet Diagnosed OM.Osteomyelitis PJI.. Prosthetic Joint Infection PMOS..Preprinted Medication Order Set SSTI.Skin and Soft Tissue Infection UTI. Urinary Tract Infection VAP....Ventilator Associated Pneumonia VC Villa Caritas Prepared by the Covenant Health Antimicrobial Stewardship Committee (CHASC) for the period of July December
Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report
Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report January June 215 Table of Contents I. Introduction... 3 II. CHASC Antimicrobial Utilization Reports... 4 III. Executive Summary...
More informationMisericordia Community Hospital (MCH) Antimicrobial Stewardship Report. July December 2013 Second and Third Quarters 2014
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report July December 213 Second and Third Quarters
More informationGrey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report to 214 Table of Contents I. Introduction..
More informationGrey Nuns Community Hospital (GNCH) Antimicrobial Stewardship July December 2017
Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship July December 217 Table of Contents Table of Contents... 2 I. Executive Summary... 3 II. GNCH Total Antimicrobial Utilization... 4 III. GNCH
More informationSt. Joseph s General Hospital Vegreville. and. Mary Immaculate Care Centre. Antimicrobial Stewardship Report
St. Joseph s General Hospital Vegreville and Mary Immaculate Care Centre Antimicrobial Stewardship Report January to June 217 Introduction Antibiotics are among the most commonly prescribed medications
More informationAntimicrobial 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 informationAntimicrobial 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 informationWorkplan on Antibiotic Usage Management
IMPACT Forum: Antibiotic Guideline in Perspective Workplan on Antibiotic Usage Management Dr. Raymond Yung Consultant Microbiologist PYNEH 20 April 2002 May 2002 Dr. Raymond Yung 1 Objective 1. Heighten
More informationHealthcare 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 informationOptimizing 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 informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
More informationPRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE
PRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE Global Alliance for Infection in Surgery World Society of Emergency Surgery (WSES) and not only!! Aims - 1 Rationalize the risk of antibiotics overuse
More informationRecommendations for Implementation of Antimicrobial Stewardship Restrictive Interventions in Acute Hospitals in Ireland
Recommendations for Implementation of Antimicrobial Stewardship Restrictive Interventions in Acute Hospitals in Ireland A report by the Hospital Antimicrobial Stewardship Working Group, a subgroup of the
More informationAntimicrobial Update. Alison MacDonald Area Antimicrobial Pharmacist NHS Highland April 2018
Antimicrobial Update Alison MacDonald Area Antimicrobial Pharmacist NHS Highland alisonc.macdonald@nhs.net April 2018 Starter Questions Setting the scene... What if antibiotics were no longer effective?
More informationJump 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 informationAntimicrobial 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 informationUPDATE 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 informationAntimicrobial Stewardship Program: Local Experience
Antimicrobial Stewardship Program: Local Experience Dr. WU Tak Chiu Associate Consultant Division of Infectious Diseases Department of Medicine Queen Elizabeth Hospital 18th January 2011 QUEEN ELIZABETH
More informationAntimicrobial Stewardship
Antimicrobial Stewardship Annual Report 216-217 Prepared by the Fraser Health Antimicrobial Stewardship Program June 217 Contents Executive Summary... 3 Background... 4 ASP Team Members... 5 Ackowledgements...
More informationGENERAL NOTES: 2016 site of infection type of organism location of the patient
GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered
More informationAntimicrobial 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 informationAntibiotic Stewardship at MetroWest Medical Center. Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee
Antibiotic Stewardship at MetroWest Medical Center Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee Antibiotic Stewardship Committee Subcommittee of Pharmacy and Therapeutics. Also
More information11/22/2016. 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 information21 st Expert Committee on Selection and Use of Essential Medicines Peer Review Report Antibiotics Review
(1) Have all important studies/evidence of which you are aware been included in the application? Yes No Please provide brief comments on any relevant studies that have not been included: (2) For each of
More informationHealthcare-associated Infections and Antimicrobial Use Prevalence Survey
Healthcare-associated Infections and Antimicrobial Use Prevalence Survey Shamima Sharmin, M.B.B.S., MSc, MPH Emerging Infections Program New Mexico Department of Health Agenda Recognize healthcare-associated
More informationAntibiotic 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 informationPromoting 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 informationAntimicrobial stewardship in managing septic patients
Antimicrobial stewardship in managing septic patients November 11, 2017 Samuel L. Aitken, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases slaitken@mdanderson.org Conflict of interest
More informationSolution Title: Antibiotic Stewardship: A Journey Toward the Triple Aim
Solution Title: Antibiotic Stewardship: A Journey Toward the Triple Aim Program/Project Description, including Goals What was the problem to be solved? How was it identified? What baseline data existed?
More information1. List three activities pharmacists can implement to support. 2. Identify potential barriers to implementing antimicrobial
OPTIMIZING ANTIMICROBIAL STEWARDSHIP: IT STARTS IN THE EMERGENCY DEPARTMENT! 1 2 Objectives 1. List three activities pharmacists can implement to support health-system antimicrobial stewardship programs
More informationAn audit of the quality of antimicrobial prescribing
An audit of the quality of antimicrobial prescribing Rakhee Patel, Antimicrobial Pharmacist Alison Williams, Antimicrobial Technician & Dr Armando Gonzalez-Ruiz May 2011 ICE Score 2 Introduction & Aims
More informationCollecting 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 informationPIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS
PIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS The current supply of piperacillin- tazobactam should be reserved f Microbiology / Infectious Diseases approval and f neutropenic sepsis, severe sepsis
More informationBest Practices: Goals of Antimicrobial Stewardship
Best Practices: Goals of Antimicrobial Stewardship Gail Scully, M.D, M.P.H. and Elizabeth Radigan, PharmD, BCPS UMass Memorial Medical Center Division of Infectious Disease Department of Medicine September
More informationAntimicrobial utilization: Capital Health Region, Alberta
ANTIMICROBIAL STEWARDSHIP Antimicrobial utilization: Capital Health Region, Alberta Regionalization of health care services in Alberta began in 1994. In the Capital Health region, restructuring of seven
More informationSafe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times
Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University
More informationANTIBIOTIC 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 informationMHA/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 informationDuke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients
Duke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients PURPOSE Fever among neutropenic patients is common and a significant cause of morbidity
More informationDr. Shaiful Azam Sazzad. MD Student (Thesis Part) Critical Care Medicine Dhaka Medical College
Dr. Shaiful Azam Sazzad MD Student (Thesis Part) Critical Care Medicine Dhaka Medical College INTRODUCTION ICU acquired infection account for substantial morbidity, mortality and expense. Infection and
More informationFollow this and additional works at: Part of the Pharmacy and Pharmaceutical Sciences Commons
Butler University Digital Commons @ Butler University Undergraduate Honors Thesis Collection Undergraduate Scholarship 2017 Evaluating Prescriber Adherence to Guideline- Based Treatment Pathways of a Newly
More information03/09/2014. 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 informationAntimicrobial 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 informationAntimicrobial Stewardship
Antimicrobial Stewardship Annual Report 2015-2016 Prepared by the Fraser Health Antimicrobial Stewardship Program August 2016 Contents Executive Summary... 3 Background... 4 ASP Team Members... 5 Ackowledgements...
More informationANTIMICROBIAL STEWARDSHIP PROGRAM ANNUAL REPORT How you want to be treated.
ANTIMICROBIAL STEWARDSHIP PROGRAM ANNUAL REPORT 2016-17 How you want to be treated. Table of Contents Executive Summary Background Team Clinical Activities Financials Appendix Return to Table of Contents
More informationCommunity-Associated C. difficile Infection: Think Outside the Hospital. Maria Bye, MPH Epidemiologist May 1, 2018
Community-Associated C. difficile Infection: Think Outside the Hospital Maria Bye, MPH Epidemiologist Maria.Bye@state.mn.us 651-201-4085 May 1, 2018 Clostridium difficile Clostridium difficile Clostridium
More informationANTIMICROBIAL STEWARDSHIP START SMART THEN FOCUS Guidance for Antimicrobial Stewardship for SHSCT
ANTIMICROBIAL STEWARDSHIP START SMART THEN FOCUS Guidance for Antimicrobial Stewardship for SHSCT CLINICAL GUIDELINES ID TAG Title: Prepared by Specialty / Division: Directorate: Antimicrobial Stewardship
More informationThese recommendations were approved for use by the Pharmaceutical and Therapeutics Committee, RCWMCH on 1 February 2017.
Antibiotic regimens for suspected hospital-acquired infection (HAI) outside the Paediatric Intensive Care Unit at Red Cross War Memorial Children s Hospital (RCWMCH) Lead author: Brian Eley Contributing
More informationThis survey was sent only to EIN members with a pediatric infectious diseases practice.
Infectious Diseases Society of America Emerging Infections Network Report for Query: Pediatric Outpatient Parenteral Antibiotic Therapy (OPAT) Overall response rate: 188/281 (66.9%) physicians responded
More informationANTIMICROBIAL STEWARDSHIP PROGRAM. Providence Health Care ANNUAL REPORT
ANTIMICROBIAL STEWARDSHIP PROGRAM Providence Health Care ANNUAL REPORT 2015 2016 T A B L E O F C O N T E N T S ASP ANNUAL REPORT 2015 2016 2 Clinical Activities 10 Executive Summary 3 Financials 24 Education
More informationAntibiotic 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 informationCommonwealth 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 informationDr. 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 informationAntimicrobial 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 informationAntibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More informationPharmacist Coordinated Antimicrobial Therapy: OPAT and Transitions of Care
Pharmacist Coordinated Antimicrobial Therapy: OPAT and Transitions of Care Jennifer McCann, PharmD, BCCCP State Director of Clinical Pharmacy Services St. Vincent Health Indiana Conflicts of Interest No
More informationAntimicrobial Stewardship Program 2 nd Quarter
Antimicrobial Stewardship Program 2 nd Quarter May 19, 2016 Jill Hanson, WHA DeAnn Richards, MetaStar Objectives for Today Hospital Highlight UnityPoint Health - Meriter Status of the state Update on pilot
More informationImpact 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 informationNational Clinical Guideline Centre Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults
National Clinical Guideline Centre Antibiotic classifications Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults Clinical guideline 191 Appendix N 3 December 2014
More informationSuggestions for appropriate agents to include in routine antimicrobial susceptibility testing
Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory
More informationTreatment of Surgical Site Infection Meeting Quality Statement 6. Prof Peter Wilson University College London Hospitals
Treatment of Surgical Site Infection Meeting Quality Statement 6 Prof Peter Wilson University College London Hospitals TEG Quality Standard 6 Treatment and effective antibiotic prescribing: People with
More informationInfectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles
Infectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles Conflicts of Interest None at this time May be discussing off-label indications KALIN M. CLIFFORD, PHARM.D., BCPS,
More informationANTIBIOTIC 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 informationOverview 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 informationPharmacist-Driven ASP. Jessica Holt, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Coordinator October 24 th, 2013
Pharmacist-Driven ASP Jessica Holt, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Coordinator October 24 th, 2013 Abbott Northwestern Hospital Largest not-for-profit hospital in the Twin Cities area
More information* gender factor (male=1, female=0.85)
Usual Doses of Antimicrobials Typically Not Requiring Renal Adjustment Azithromycin 250 500 mg Q24 *Amphotericin B 1 3-5 mg/kg Q24 Clindamycin 600 900 mg Q8 Liposomal (Ambisome ) Doxycycline 100 mg Q12
More informationHealth PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults
Health PEI: Provincial Antibiotic Advisory Team Empiric Antibiotic Treatment Guidelines for Sepsis Syndromes in Adults COMMUNITY-ACQUIRED PNEUMONIA HEALTHCARE-ASSOCIATED PNEUMONIA INTRA-ABDOMINAL INFECTION
More informationProvincial Drugs & Therapeutics Committee Memorandum Version 2
Provincial Drugs & Therapeutics Committee Memorandum Version 2 16 Garfield Street 16, rue Garfield PO Box 2000, Charlottetown C.P. 2000, Charlottetown Prince Edward Island Île-du-Prince-Édouard Canada
More informationInappropriate Use of Antibiotics and Clostridium difficile Infection. Jocelyn Srigley, MD, FRCPC November 1, 2012
Inappropriate Use of Antibiotics and Clostridium difficile Infection Jocelyn Srigley, MD, FRCPC November 1, 2012 Financial Disclosures } No conflicts of interest } The study was supported by a Hamilton
More informationMercy Medical Center Des Moines, Iowa Department of Pathology. Microbiology Department Antibiotic Susceptibility January December 2016
Mercy Medical Center Des Moines, Iowa Department of Pathology Microbiology Department Antibiotic Susceptibility January December 2016 These statistics are intended solely as a GUIDE to choosing appropriate
More information4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES
CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA BILLIE BARTEL, PHARMD, BCCCP APRIL 7 TH, 2017 DISCLOSURE I have had no financial relationship over the past 12 months with any commercial
More informationUnderstanding 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 informationInteractive session: adapting to antibiogram. Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe
Interactive session: adapting to antibiogram Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe Case 1 63 y old woman Dx: urosepsis? After 2 d: intermediate result: Gram-negative bacilli Empiric antibiotic
More information9/30/2016. 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 informationNew Drugs for Bad Bugs- Statewide Antibiogram
New Drugs for Bad Bugs- Statewide Antibiogram Felicia Matthews, Pharm.D., BCPS Senior Consultant, Pharmacy Specialty BE MedMined Services Disclosures Employee of BD Corporation MedMined Services Agenda
More informationAntimicrobial 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 informationAntimicrobial Stewardship: The Premier Health Experience
Antimicrobial Stewardship: The Premier Health Experience Steve Burdette, MD, FIDSA Professor of Medicine Wright State University Boonshoft School of Medicine Director of Antimicrobial Stewardship Miami
More informationEffectiv. q3) Purpose of Policy. Pharmacy: Antimicrobial subcommp&tittee of
Name ofpolicynupolicy:mber: Department: Approving Officer: Responsible Agent: Scope: Protected Antimicrobials 3364-133-106 Pharmacy: Antimicrobial subcommp&tittee of Chief Executive Officer Director of
More informationIntroduction. Antimicrobial Usage ESPAUR 2014 Previous data validation Quality Premiums Draft tool CDDFT Experience.
Secondary Care Data Validation: What do commissioners need to know? Stuart Brown Healthcare Acquired Infection and Antimicrobial Resistance Project Lead NHS England March 2014 Introduction Antimicrobial
More informationInfection Prevention Highlights for the Medical Staff. Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention
Highlights for the Medical Staff Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention Standard Precautions every patient every time a. Hand Hygiene b. Use of Personal Protective Equipment (PPE)
More informationAppropriate antimicrobial therapy in HAP: What does this mean?
Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,
More informationApril 25, 2018 Edited by: Gregory K. Perry, PharmD, BCPS-AQID
VOLUME FOUR; ISSUE 4 April 25, 2018 Edited by: Gregory K. Perry, PharmD, BCPS-AQID InPHARMation Pharmacy and Therapeutics Committee Update April 25 th, 2018 Meeting The Pharmacy and Therapeutics Committee
More informationClinical Guideline. District Infectious Diseases Management. Go to Guideline. District Infectious Diseases Management CG 18_24
Clinical Guideline District Infectious Diseases Management Sites where Clinical Guideline applies All facilities This Clinical Guideline applies to: 1. Adults Yes 2. Children up to 16 years Yes 3. Neonates
More informationAntimicrobial Stewardship/Statewide Antibiogram. Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services
Antimicrobial Stewardship/Statewide Antibiogram Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services Disclosures Employee of BD Corporation MedMined Services Agenda CMS and JCAHO
More informationJump Start Stewardship
Jump Start Stewardship Webinar 2: Building your Stewardship Team and Selecting Interventions and Targets for your Implementation Welcome Thank you for your time today This webinar will be recorded for
More informationAntimicrobial 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 informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
More informationAntibiotic Stewardship and Critical Access Hospitals. Robert White, BA, PT, CPHQ Program Manager TMF Quality Innovation Network
Antibiotic Stewardship and Critical Access Hospitals Robert White, BA, PT, CPHQ Program Manager TMF Quality Innovation Network Antibiotic-Resistant Bacteria A serious threat to public health and the economy
More informationQuality indicators and outcomes in the devolved nations Scotland
Quality indicators and outcomes in the devolved nations Scotland Dr Jacqueline Sneddon, MRPharmS Project Lead, Scottish Antimicrobial Prescribing Group Federation of Infection Societies Conference Birmingham,
More informationImplementing Antibiotic Stewardship in Rural and Critical Access Hospitals
National Center for Emerging and Zoonotic Infectious Diseases Implementing Antibiotic Stewardship in Rural and Critical Access Hospitals Denise Cardo, MD Director, Division of Healthcare Quality Promotion,
More informationAntimicrobial Stewardship: Stopping the Spread of Antibiotic Resistance
Antimicrobial Stewardship: Stopping the Spread of Antibiotic Resistance Natalie Weber, PharmD PGY2 Critical Care Pharmacy Resident September 22, 2016 The speaker has no actual or potential conflicts of
More informationAntimicrobial 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 information2016/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 informationAntimicrobial Stewardship: A Matter of Process or Outcome?
Antimicrobial Stewardship: A Matter of Process or Outcome? Tina M. Khadem, Pharm.D., Elizabeth Dodds Ashley, Pharm.D., M.H.S., Mark J. Wrobel, Pharm.D., and Jack Brown, Pharm.D., M.S. The risk of antimicrobial
More informationAntibiotic 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 informationAntimicrobial Stewardship Program
Antimicrobial Stewardship Program David R. Woodard, MSc, FSHEA, CIC CDC: Antibiotic Resistance Threats in the United States, 2013 http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ CDC Threat Levels
More informationToday s webinar will begin in a few minutes.
Today s webinar will begin in a few minutes. Please press *6 to mute your line or use the mute button on your phone. If you have questions for the presenter or need to contact TCPS staff, type your comments
More informationThe 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 informationIntra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
More informationGeneral Approach to Infectious Diseases
General Approach to Infectious Diseases 2 The pharmacotherapy of infectious diseases is unique. To treat most diseases with drugs, we give drugs that have some desired pharmacologic action at some receptor
More information