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Antimicrobial Stewardship Team Rethinks Use of Antibiotics


Above: Lawrence General's Antimicrobial Team

The term “superbug” has made its way into an increasing number of headlines in recent years, and with good reason. Superbugs are strains of infection-causing bacteria that have become resistant to antibiotics due to over use. These adaptive bacteria are becoming a serious concern around the world as more patients contract infections for which there are few or no effective antibiotic treatments.

So serious is the concern around superbugs that the Centers for Disease Control and Prevention (CDC), Centers of Medicare and Medicaid Services (CMS), and the Joint Commission have all made reducing inappropriate antibiotic usage a national priority. Each of these agencies now requires that hospitals have an antimicrobial stewardship program (ASP) to monitor and manage the use of antibiotics on a local level.

"We put together our antimicrobial stewardship team in November of 2015, with representation from a number of different clinical areas,” says Aimee Mertz, PharmD, pharmacy clinical manager. “Our initial goal has been to focus on the common disease states that we see at Lawrence General and make sure we are following the national guidelines put out by the regulatory agencies.”

The team is also updating and standardizing some of the medication order sets for common diseases, such as pneumonia and urinary tract infections, and educating clinical staff about antibiotic resistant organisms and the appropriate use of antimicrobial medications. Educational information is also being provided to patients. Additionally, the ASP team is exploring innovative ways of keeping patients off unnecessary antibiotics entirely.

"We are currently piloting a new procalcitonin blood test that will help us make quick decisions about discontinuing antibiotics for patients admitted with pneumonia-like symptoms," says Tim Keaney, PharmD, director of pharmacy. "As a first course of action, patients are often put on an antibiotic. But antibiotics only work on bacterial infections, not viral. So, the sooner you can rule out pneumonia and make a proper diagnosis, the sooner you can discontinue the antibiotics."

Moving forward, the ASP team (pictured right) will continue to analyze data on the use of antibiotics at Lawrence General, updating order sets and improving clinical practices as they go to ensure that patients always receive the most appropriate antimicrobial regimen.

"Antibiotics aren't always the answer and antibiotic stewardship is a way to balance the risks and potential benefits," says Tim. "By getting the right people at the table and examining our practices from a number of different angles, we will be able to improve outcomes, shorten lengths of stay, enhance patient flow, and reduce costs."

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