The Key to Successful Antimicrobial Stewardship: Interdisciplinary Teams

Antimicrobial resistance is on the rise. As multi-drug resistant microorganisms (MDRO) continue to develop, many infections are now more difficult to manage.

Antimicrobial stewardship refers to the conscientious use of antimicrobials in ways that improve patient outcomes, reduce microbial resistance, and decrease the incidence of MDRO infections. Specifically, it is a formalized program to provide advice, consent, and institutional guidance on the appropriate selection, dosing, route, and duration of antimicrobial treatment.

In addition to a focus on appropriate and effective therapies that optimize patient outcomes, stewardship goals should include reduced incidence of Clostridium difficile infections (CDI), less new antimicrobial resistance, and lower hospital costs.

Clostridium difficile Infections

The U.S. incidence of CDI has increased substantially. Recent estimates indicate nearly half a million cases acquired from hospitals, the community, and nursing homes, which were responsible for 28,500 deaths and incurred costs of $3.8 billion. Moreover, the rate of CDI cases and mortality has risen sharply since around 2000 due in part to a new, more-virulent strain of C. difficile.

However, reducing CDI infections is less dependent on preventive tactics and more on limiting the number and types of antibiotics administered and the duration of treatments.

• The likelihood of CDI increases with each additional antibiotic that the patient receives
• In the U.S., the heavy use of fluoroquinolone-type antibiotics (ciprofloxacin, levofloxacin, and moxifloxacin) contributes to CDI rates
• Current standard practice calls for shorter courses of antimicrobial treatment
• Shorter treatments are as effective and help to limit antimicrobial resistance development

Drug Resistance and Antibiotic Choice

Antibiograms can be very helpful in determining which medications are most likely to be effective in specific situations. The laboratory plays a key role in compiling current antibiograms and creating combination antibiograms for new medication combinations. 

The choice of treatment and prompt delivery with biologically active antibiotics is critical to successfully treating infections. Growing antibiotic resistance means that some traditional treatments aren’t working, and some novel treatments may be expensive. 

An Antimicrobial Stewardship Team

An interdisciplinary team approach can be an effective way to address this issue. Teams should include a pharmacist dedicated to antimicrobial stewardship, the pharmacy director, an infectious disease physician, a doctor who regularly treats patients, at least one licensed nurse, the lab director, and a lab tech.

The effective treatment of patients with drug-resistant infections requires the expertise of and support from representatives of different disciplines.

Watch the full webinar on demand for more details.

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This webinar is produced by Whitehat Communications, a provider of continuing education programs in clinical laboratory sciences that has been approved by the ASCLS P.A.C.E.™ Program. One P.A.C.E. credit hour will be provided for this complimentary, basic-level program.

James A. McKinnell, MD

Dr. McKinnell is an Assistant Professor of Medicine in the David Geffen School of Medicine at the University of California, Los Angeles. He is also a member of the Infectious Disease Clinical Outcome Research Unit (ID-CORE) and the Los Angeles Biomedical Research Institute at Harbor-UCLA.

McKinnell is a nationally recognized infectious disease specialist with specific research interests related to the clinical management and prevention of healthcare-associated infections. He has published more than 40 papers, many of which emphasize antimicrobial resistance within the community and the optimal use of antibiotics.