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Antimicrobial Stewardship (AMS) at Mercy Medical Center

There is a Joint Commission standard that requires education about antimicrobial stewardship for all staff including LIPs.

Antibiogram & Antibiotic Quick Reference

What are ASPs?

  • Coordinated interventions and processes designed to optimize antimicrobial use1

  • Goal is to ensure that all patients are receiving the right drug at the right dose and for the right duration to improve outcomes and prevent unintended consequences (C. diff, adverse reactions, antimicrobial resistance)

Why are ASPs important?

  • Antimicrobials are not harmless. Up to 30-50% of antimicrobials used in acute care hospitals are unnecessary or inappropriate (e.g. wrong drug, dose, or duration)2 which leads to

    • Acceleration in the rate of antimicrobial resistance

    • Selection of pathogenic organisms, such as Clostridium difficile

    • Toxicity (up to 20% of hospitalized patients who receive an antibiotic have an adverse effect4)

  • Antimicrobial resistance is an increasing global threat

    • At least 2 million infected with resistant bacteria each year in the U.S. and at least 23,000 die3

  • A decrease in the number of new antimicrobials being developed and approved

  • Joint Commission AMS Standards and CMS Conditions of Participation became effective January 2017 and March 2020, respectively

What does Mercy’s ASP do?

  • Multidisciplinary Antimicrobial Stewardship (AMS) Committee that meets every other month

  • Review of antimicrobial regimens by the AMS pharmacist and clinical pharmacists and provide recommendations

  • Report antimicrobial use and resistance data, including a yearly antibiogram (see MD Weblinks in Epic > Antibiogram and Antibiotic Quick Reference)

  • Order set review/implementation and facility-specific treatment guidelines

    • Order sets: pneumonia, C. diff, skin/soft tissue infection (cellulitis and DFI), sepsis, STDs

    • Facility-specific treatment guidelines: include the above plus several more, in Epic MD Weblinks > Antibiogram and Antibiotic Quick Reference

    • COVID-19: see COVID-19 Inpatient Treatment Guidance in Epic MD Weblinks

  • Policies/protocols (AMS policy, piperacillin/tazobactam extended infusion, meropenem and cefepime dose optimization, IV to PO, renal dosing, antibiotic restriction, penicillin allergy testing)

  • Antimicrobial timeout at 48-72 hrs of therapy (trigger tool to stop and assess therapy): piperacillin/tazobactam, cefepime, and meropenem

  • Optimize rapid diagnostics (examples: blood culture PCR panel > will result with blood culture Gram stain and identifies 23 of most common blood pathogen species + resistance markers)à Pharmacist will call initial blood culture results to provider & discuss therapy

  • Research projects and medication use evaluations

  • Education

What can providers do to practice AMS?

  • Utilize AMS pharmacy services

  • Choose the correct indication and dose when ordering antimicrobials

  • Refer to the antibiogram for empiric therapy

  • Review appropriateness of empiric antimicrobials daily

  • Ensure appropriate use of protected antibiotics (broad-spectrum, active against resistant pathogens)

  • De-escalate therapy

  • Apply stop dates to orders

  • Assess allergies (especially β-lactam allergy)

  • IV to PO conversion

  • Ensure correct duration of therapy for discharge antibiotics (take inpatient duration into account)

  • Use evidence based/guideline recommended treatments and durations

  • Decrease C. diff factors (decrease PPI usage, use lower risk antibiotics)

Questions? AMS Pharmacist: Megan Bernabe, PharmD, MPH, BCPS, BCIDP; mbernabe@mercycare.org; 319-221-8850

References: 1SHEA/IDSA/PIDS Policy Statement on AMS. Infect Control Hosp Epidemiol. 2012; 2https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6309a4.htm; 3https://www.cdc.gov/drugresistance/about.html 4Tamma PD, et al. JAMA Intern Med. 2017.

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