Memorial Healthcare System

 Antimicrobial Stewardship

Goal:

Optimize antimicrobial treatment outcomes while minimizing drug related adverse events (including resistance)

Background: 

Appropriate use of antimicrobials has demonstrated the potential to improve efficacy, decrease treatment related costs, minimize drug related adverse events, and limit the potential for emergence of antimicrobial resistance.

Method:

Establish Antimicrobial Stewardship Program for MHCS with core management by clinical pharmacists working closely with an Infectious disease physician. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have advocated for this and published consensus guidelines for establishing a program.*

Current State:

• Widespread resistance, leading to potentially untreatable infections
• Lack of new agents in development & corresponding lack of incentives
• Random retrospective chart review of 20 MHCS patients receiving antimicrobials: 16/20 (80%) had opportunities

Tactics:

• Education & Optimization of MHCS Antibiogram
• Development and use of Evidence Based Order Sets
• De-escalation of therapy
• Active antimicrobial surveillance & monitoring
• Formulary restriction
• Optimization of dose, route, and duration through application of pharmacokinetic properties
• Implementation of Clinical Decision Support Software
• Leadership of Regional Antimicrobial Stewardship Committee (Kick-off meeting held August 26)

* Dellit TH et al. Clin Infect Dis. 2007;44:159-177 and Clin Infect Dis.1997:24:471-485