John H Stroger Jr Hospital of Cook County

John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois

WHO – ID Physicians and Pharmacists Identifying stewardship opportunities through surveillance activities, anecdotal experiences Organizing and implementing stewardship Over-sight of AMS activities Becca Peglow, MD Developing resources to support AMS staff rd 3 year ID Fellow, Antimicrobial - Guidelines Stewardship - Shortages Monitoring effects of ASP activities Gail Itokazu, Pharm. D David Schwartz, MD Chairman, Division of Infectious Diseases Robert Glowacki, Pharm. D Clinical Pharmacists (Medical/surgical wards, ICUs) Back-up for front-line ASP staff (uncertainties surrounding antibiotic use) Katayoun Rezai, MD Attending, ID Director, Outpatient Antimicrobial Therapy Program (OPAT) Back-up for AMS staff ID-MD Fellows Bacteremia surveillance Back-up for AMS staff

ASP Activities: What Why Where When Institutional Guidelines Empiric treatment of common infection syndromes Diagnosis, Drug, Dose, Duration, De-escalation Request from Internal Medicine attending, “How to treat common infections” Hospital-wide Readily accessible via the electronic medical record 2004 - present

ASP Activities: What Why Antimicrobial use in diabetic foot infections (DFIs) Educational intervention Excessively broad-spectrum abx often prescribed - MSSA, Group B strep common* - piperacillin/tazobactam plus vancomycin rx Where When Practice is hard to change Family Medicine Service 2011 – present …. . ICHASE *deep wound cultures obtain by Podiatry Service

Illinois Collaborative for Hospital Antimicrobial Stewardship Enhancement (ICHASE) • Collaboration CDC, IDPH and 5 other hospitals in Illinois to improve Antimicrobial stewardship • Educational Intervention – Empower clinicians with the knowledge to manage abx for DFIs – Lecture series by ID-MD Fellow and Family Medicine Resident – Institutional guideline use 5

Look in chart for previous culture data to help guide empiric therapy 6

Preliminary findings…. Pre-intervention (n=37) Post-intervention (n=26) Guideline adherence* 13 (35%) 16 (62%) Acceptance of recommendations 19 (95%) 15 (100%) DOT / 100 patient days Piperacillin/tazobactam 65 31 Vancomycin 53 48 Ampicillin/sulbactam 32 68 * Initiation of guideline recommended empiric therapy by targeted service; data represents 2 months of surveillance in 2012 and 2014. 7

Lessons • Targeted educational intervention – improved adherence to institutional guideline for the initial selection of antimicrobials • Clinician buy-in and involvement during the planning of the intervention • Longer term effect of intervention needs to be evaulated 8

Next steps • Vascular /Podiatry services – Better utilization of resources – Decrease length of stay – Optimizing antibiotic utilization • Assess the clinical and economic outcomes of continued audit and feedback by Physician Assistant 9