Pharmacy
Antimicrobial Stewardship Program
The global rise in antibiotic resistance, coupled
with the limited development of new agents, has
presented new challenges for clinicians treating
patients with bacterial infections. For this reason,
antimicrobial stewardship has become a key strategy
for health care institutions to help curb the rise in
antibiotic resistance. Overuse and misuse of antibiotics
not only contribute to an increased cost of care,
but may also result in unintended consequences,
such as emergence of resistance or development
of C. difficile infection.
Restricted Antimicrobial Guidelines
In order to support antimicrobial stewardship,
hospitals have a list of restricted antimicrobials.
These agents represent antimicrobials which should
be specifically targeted by antimicrobial stewardship
efforts. These agents may require an ID provider's/
designee's approval or need to meet the criteria for
use. Therefore, providers may be contacted by
pharmacy if the criteria are not met.
Prospective Audit and Feedback
Prospective audit and feedback is one of two core
antimicrobial stewardship strategies recommended
by the Infectious Diseases Society of America, Society
of Healthcare Epidemiology of America and CDC Core
Elements of Hospital Antimicrobial Stewardship
Programs. Prospective audit and feedback consists
of a case-by-case prospective review by an clinical
pharmacist. Cases are reviewed for antimicrobial
appropriateness, and feedback with education is
delivered directly to the provider caring for the patient,
with the goal of improving antimicrobial use.
Prospective audit and feedback has been shown to
improve antimicrobial use, reduce antimicrobial
resistance, and reduce C. difficile rates, without a
negative impact on outcomes.
Antibiograms
Antibiogram shows the local percentage susceptibility
of an organism to antimicrobial agents and is utilized
to guide for empiric therapy selection. Antimicrobial
stewardship team works on antibiogram annually and
posts on Epic.
MRSA Nasal Screening for De-Escalation
of Empiric Anti-MRSA Therapy for Pneumonia
Treatment of pneumonia often lacks microbiological
data to streamline empiric antibiotics. Lower respiratory
tract cultures, while preferred, are often difficult to
obtain. Additionally, poor-quality samples may not
accurately reflect the primary pathogen. Data from
both critically and non-critically ill patients show
that nasal MRSA screening can be effective to guide
de-escalation of vancomycin and linezolid. A negative
nasal MRSA result has a negative predictive value
of >98% for MRSA pneumonia and can be used to safely
de-escalate vancomycin or linezolid (CLICK HERE and
refer to information in the document on Sharepoint).
If MRSA nasal screening is available, pharmacists may
order per protocol to guide de-escalation of unnecessary
empiric coverage of MRSA pneumonia if the system
protocol criteria are met (CLICK HERE and refer to
information in the document on Sharepoint).
If the MRSA nasal screening is negative, the clinical
pharmacist will contact the provider to consider the
de-escalation of anti-MRSA therapy and document
the provider's response.
Provider Education Training Manual 16
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