Beyond the Basics:Overcoming Obstacles and Advancing Your Stewardship Program

Amanda Novack, MD

Medical Director, ID ArkansasJuly 18, 2019

Arkansas Antibiotic Stewardship and Infection Prevention Collaborative

Objectives

Antibiotic Resistance Threat in the US, Executive Report. 2013. CDC

Antimicrobial Stewardship

uAntibiotics are different from other drugsuEfficacy wanes over time

uThey are a shared resource

u Individual use may harm others

Antimicrobial Stewardshipu Coordinated interventions to optimize

uBest antibioticuBest doseuBest durationuBest route

u Aim is to decrease selective pressure for multidrug-resistant organisms in order to preserve the utility of antibacterial agents.

u Leads to improved patient outcomes, increased patient safety, and decreased risk of C. diff.

Seven Core Elements of ASP

uLeadership CommitmentuAccountability uDrug ExpertiseuActionu TrackinguReportinguEducation

Seven Core Elements of ASP

uLeadership Commitment ÖuAccountability ÖuDrug ExpertiseuActionu TrackinguReportinguEducation

“CDC Antibiotic Use Continuing Education”

Seven Core Elements of ASP

uLeadership Commitment ÖuAccountability ÖuDrug Expertise ÖuActionu TrackinguReportinguEducation

Action

u“48 hour time out”u These reviews can focus on three important

questions: uIs an antibiotic still needed? uIf so, is the antibiotic tailored to the culture

results (e.g. is the narrowest spectrum agent being used?)

uAnd, how long should the antibiotic be used?

Actionu Nurses play an important role

u Review culture techniques to ensure that microbiology cultures are collected properly

u Review culture results with the treating clinician u Monitor response to antibiotic therapyu Assess oral intake to alert providers when a patient can convert from IV

to POu Educate patients about potential adverse effects of antibiotics,

especially C. difficileu Nurses are also well positioned to initiate “antibiotic time-outs” with the

treating clinician and pharmacist, and review antibiotic therapy after 48 hours of treatment.

ActionuRestricted antibiotics

Tracking

Reportingu Data on stewardship efforts should be reported not just to

providers, but also to the hospital leadership and board

u A key to success is to discuss reporting options with stakeholders to determine optimal timing, format and delivery methods for the reports.

u Prepare regular reports on the measures being tracked

u If feasible, share provider-specific reports with individual clinicians confidentially

Provider Report Cards

Next phase of Stewardship: Communication

Next phase of Stewardship: Diagnostics

Next phase of Stewardship: New antibiotics

u 2014: Dalbavancin, Oritavancin, Tedizolid, Ceftolozane-tazobactam

u 2015: Ceftazidime-avibactam, Isavuconazole

u 2017: Delafloxacin, Meropenem-vaborbactam

u 2018: Omadacycline, Eravacycline, Plazomicin

u Future: Iclaprim? Lasculfloxacin? Lefamulin? Sulopenem?