Policies and procedures

Meropenem/vabobactam susceptibility testing will be added to the automatic restricted drug panel set up for carbapenemase producing Enterobacteriaciae (CRE) by the clinical microbiology laboratory. As part of the existing on-call program, the Antimicrobial Stewardship Program (ASP) pharmacist will review all Gram-negative and carbapenemase positive blood culture isolates and susceptibility results in real-time. During physician office hours (M-F 8-5), the attending physician or service line provider will be contacted by the antimicrobial stewardship responding pharmacist to discuss treatment options and to convey infectious diseases consultation requirement for use of the restricted agent. If a care provider cannot be reached within 1 hour, the ASP pharmacist may enter the order for the restricted antibiotic per Medical Staff Approved Policy (i.e. Standing Order – Defined in PCPS092_HM Clinical Practice Guidelines, Protocols, Order Sets, Pathways, Standing Orders) so as not to delay therapy and quality of patient care. Outside of physician office hours, the ASP responding pharmacist at each hospital will review each patient case and determine whether the use of a restricted antibiotic is appropriate on a case by case basis. In all cases, the attending physician and/or care team will be contacted within 24 hours to discuss the care of the patient and convey that the restricted agent is only approved for a 24 hour window pending ID consultation. If primary service refuses to consult the ID service, then alternative therapy will be recommended by the ASP pharmacy team and the restricted agent will be discontinued. In the case of a cephalosporin or penicillin allergy, physicians will be contacted to discuss alternative options as needed and use of a restricted agent will be at the discretion of the physician. ASP pharmacist orders for restricted antibiotics will be entered by the ASP pharmacist per medical staff approved Policy.

Consults, protocols, and therapeutic interchanges

Additional information

Houston Methodist Antimicrobial Stewardship page

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