Transcript Back-up - Antimicrobial Stewardship

John H. Stroger Jr. Hospital of Cook
County, Chicago, Illinois
WHO – ID Physicians and Pharmacists
David Schwartz, MD
Chairman, Division of Infectious
Diseases
Over-sight of AMS activities
Becca Peglow, MD
3rd year ID Fellow, Antimicrobial
Stewardship
Gail Itokazu, PharmD
Robert Glowacki, PharmD
Clinical Pharmacists
(Medical/surgical wards, ICUs)
Identifying stewardship opportunities through
surveillance activities, anecdotal
experiences
Organizing and implementing stewardship
activities
Developing resources to support AMS staff
- Guidelines
- Shortages
Monitoring effects of ASP activities
Back-up for front-line ASP staff (uncertainties
surrounding antibiotic use)
Katayoun Rezai, MD
Attending, ID
Director, Outpatient Antimicrobial Therapy Program
(OPAT)
Back-up for AMS staff
ID-MD Fellows
Bacteremia surveillance
Back-up for AMS staff
ASP Activities:
What
Why
Where
When
Institutional Guidelines
Empiric treatment of common infection
syndromes
Diagnosis, Drug, Dose, Duration,
De-escalation
Request from Internal Medicine attending,
“How to treat common infections”
Hospital-wide
Readily accessible via the electronic medical
record
2004 - present
ASP Activities:
What
Why
Antimicrobial use in diabetic foot
infections (DFIs)
Educational intervention
Excessively broad-spectrum abx often
prescribed
- MSSA, Group B strep common*
- piperacillin/tazobactam plus vancomycin rx
Where
When
Practice is hard to change
Family Medicine Service
2011 – present …..ICHASE
*deep wound cultures obtain by Podiatry Service
Illinois Collaborative for Hospital Antimicrobial
Stewardship Enhancement (ICHASE)
• Collaboration CDC, IDPH and 5 other hospitals
in Illinois to improve Antimicrobial
stewardship
• Educational Intervention
– Empower clinicians with the knowledge to
manage abx for DFIs
– Lecture series by ID-MD Fellow and Family
Medicine Resident
– Institutional guideline use
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Look in chart for
previous culture data to
help guide empiric
therapy
6
Preliminary findings….
Pre-intervention (n=37)
Post-intervention (n=26)
Guideline adherence*
13 (35%)
16 (62%)
Acceptance of
recommendations
19 (95%)
15 (100%)
DOT / 100 patient days
Piperacillin/tazobactam 65
31
Vancomycin
53
48
Ampicillin/sulbactam
32
68
* Initiation of guideline recommended empiric therapy by targeted service;
data represents 2 months of surveillance in 2012 and 2014.
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Lessons
• Targeted educational intervention
– improved adherence to institutional guideline for
the initial selection of antimicrobials
• Clinician buy-in and involvement during the
planning of the intervention
• Longer term effect of intervention needs to be
evaulated
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Next steps
• Vascular /Podiatry services
– Better utilization of resources
– Decrease length of stay
– Optimizing antibiotic utilization
• Assess the clinical and economic outcomes of
continued audit and feedback by Physician
Assistant
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