Download Antimicrobial-stewardship-program 02-2017

Antimicrobial Stewardship
The Problem
 Antibiotic resistance is a worldwide problem
 Antibiotics are among the most commonly prescribed
drugs used in human medicine
 Up to 50% of antibiotics prescribed for people are
unnecessary or inappropriate
 Misuse of antibiotics leads to the emergence and spread
of
 antibiotic resistant organisms (e.g., methicillinresistant Staphylococcus aureus, vancomycinresistant enterococci, etc.)
 Healthcare-associated infections (e.g., Clostridium
difficile, etc.)
“…the thoughtless person playing with
penicillin treatment is morally
responsible for the death of the man
who finally succumbs to infection with
the penicillin-resistant organism.”
Alexander Fleming
National Action Plan to
Combat Antibiotic Resistance
 The Centers for Disease Control and Prevention (CDC)
advised acute care hospitals to implement antibiotic
stewardship programs (ASPs)
 The Joint Commission (TJC) implemented
antimicrobial stewardship standard MM.09.01.01
effective date January 1, 2017
 The Centers for Medicare & Medicaid Services’ (CMS)
intends to require all acute care hospitals and longterm care facilities to incorporate an ASP as a
mandatory Condition of Participation
Antibiotic Stewardship
 Antimicrobial stewardship is a coordinated
program that promotes the appropriate use of
antimicrobials including antibiotics, improves patient
outcomes, reduces microbial resistance, and
decreases the spread of infections caused by
multidrug-resistant organisms.
 Utilizes informatics, data collection, personnel, and
policy/procedures to promote optimal selection,
dosing, and duration of therapy for antimicrobial
agents throughout the course of their use
ASP Core Elements
 Leadership Commitment: Dedicating necessary
human, financial, and IT resources
 Accountability: Single physician leader responsible
for outcomes
 Drug Expertise: Single pharmacist leader
responsible for outcomes
 Action: Implementing specific, proven interventions
 Tracking: Monitoring antibiotic prescribing/resistance
patterns
 Reporting: Informing key stakeholders of progress
regarding antibiotic use & resistance
 Education: Updates on resistance & optimal
prescribing
ASP Goals
improve patient outcomes;
slow the emergence of resistance;
prevent the spread of infections;
limit toxicity associated with antimicrobials including
secondary infections (eg, Clostridium difficile);
 contain costs.
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Optimal Antimicrobial Use
All prescribers at ETMC Tyler are expected to adhere to
the following principles when prescribing antimicrobial
therapy:
Empiric therapy
 initiate promptly after collection of appropriate
specimens (whenever appropriate and possible);
 target likely pathogen and source (anatomic site of
infection);
 consider possible antimicrobial resistance based on
recent antimicrobial exposure and local resistance
patterns;
Optimal Antimicrobial Use
Empiric therapy
 select the narrowest spectrum possible for achieving
the intended effect;
 determine the appropriate dose, route and frequency
of therapy;
Tailoring therapy
 review microbiology results and broaden or narrow
therapy as appropriate;
 convert intravenous therapy to oral as soon as
possible and clinically indicated.
Duration of therapy
 use shortest effective duration of therapy.
ETMC Antimicrobial
Stewardship
 ETMC established an ASP in 2007
 ASP core membership:
 Infectious Diseases physician
 clinical pharmacists
ETMC Antimicrobial
Stewardship
ASP activities
 Prospective audit of all inpatient antimicrobial
use twice weekly
 IV to oral conversion of therapy
 Dose adjustment/optimization
 Detection and prevention of antibiotic-related
drug-drug interactions
 Improve adherence to guidelines
 Therapeutic drug monitoring
ETMC Antimicrobial
Stewardship
Tracking and Reporting
 Medication use evaluations/antibiotic
audits to assess quality of antibiotic
use
 Days of antibiotic therapy
 Detecting/monitoring trends in
antimicrobial resistance
Inappropriate use of antibiotics contributes to emergence and spread
of antibiotic resistant organisms and health-care associated
infections.
Antimicrobial stewardship is vital for preserving existing antibiotics
and improving patient outcomes while minimizing unintended
consequences.
Antibiotic prescribing should be prudent, thoughtful and rational.
It was on a short-cut through the hospital kitchens that
Albert was first approached by a member of the
Antibiotic Resistance.