Category: Antimicrobial Stewardship

Inpatient Diarrheal Illness…Don’t Flush your Money: Save it with Diagnostic Stewardship!

Recently, a multidisciplinary team at UNMC published a diagnostic stewardship study in Infection Control & Hospital Epidemiology (ICHE) entitled: Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing, that prompted a press release from The Society for Healthcare Epidemiology of America (SHEA), and a feature on an upcoming ICHE podcast episode. Drs. Jasmine Marcelin and Trevor Van […]

Jul 1, 2019

UNMC IDSHEAROES Enter the Race Against Resistance – Read Their Top Ten Reasons

Life-threatening infections caused by antimicrobial resistant organisms, commonly referred to as ‘superbugs’ have taken the media by storm. MRSA, VRE, MDRO, KPC, CRE, CDI – all acronyms that put fear in our hearts that one day, we will have run out of treatment options. That one day, our patients will die from infections that we […]

Jun 1, 2019

Do you really need to test the poo? Diagnostic stewardship for (outpatient) diarrheal illness

Rapid molecular testing has changed the landscape of diagnostic approaches to many infectious disease syndromes, including diarrheal illnesses. These panels typically have the capacity to diagnose multiple organisms in one test. The FilmArray gastrointestinal pathogen panel (BioFire) tests 22 stool pathogens. Despite the impact of improved clinical efficiency, these tests are often expensive, especially in […]

May 28, 2019

The Antimicrobial Stewardship Program: Keeper of the S. aureus bacteremia Checklist Manifesto

Staphylococcus aureus bacteremia (SAB) is a serious and sometimes devastating infection. There are established guidelines for optimal management, and more recently, numerous studies have shown the benefits of Infectious Diseases consultation, including improving guideline-adherent management, and reducing hospital stays, 30-day readmissions, and in-hospital mortality. Pharmacist-driven initiatives embedded within the Antimicrobial Stewardship Program (ASP) have also […]

May 10, 2019

When you see CRE: Add Equal Parts Antimicrobial Stewardship and Infection Control

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in April 2019. Dealing with carbapenem resistant organisms presents both an antimicrobial stewardship and infection control problem. Richter et al. aimed to predict risk factors for carbapenem resistance among Gram-negative rods (CR-GNR). The authors were particularly interested in whether differences exist […]

May 2, 2019

Does de-escalation of anti-MRSA therapy for culture-negative pneumonia affect patient outcomes?

Nosocomial pneumonia is a common hospital-acquired infection and has a high mortality rate in the critically ill.  Because drug-resistant bacteria like Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) are commonly responsible for these infections, guidelines recommend broad-spectrum empirical therapy that includes anti-MRSA coverage.  Treatment is ideally de-escalated and refined based on culture results.  However, culture negative infections […]

Apr 22, 2019

What to Expect in Antimicrobial Stewardship…Shorter is Better, Of Course!

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in February 2019. Electronic clinical decision support tools and rapid diagnostic testing have significantly impacted the way we practice Infectious Diseases. Despite these scientific gains, Antimicrobial Stewardship still requires an understanding of the behavioral science of prescribing. Prior studies have demonstrated […]

Feb 26, 2019

Prescribing in Pediatric Patients: Who is at Risk?

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in January 2019. In the inpatient setting, much of the broad-spectrum antibiotic prescribing occurs in the context of the sepsis syndrome, where uncertainty leads to overly broad empiricism. Development of antibiotic-resistant Gram-negative rods (high-risk GNRs) may complicate empiric treatment choices, and […]

Jan 31, 2019

Decisive De-labelling in Cancer Patients: Just what the Doctor Ordered

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in January 2019. Although 10% of Americans report penicillin allergies, 90% of those allergies are not substantiated. Up to 25% of patients living with cancer report penicillin allergies, but more than half of these are low risk and could tolerate beta-lactams. […]

Jan 16, 2019

SeptiCyte: Is It Ready for Prime-time?

The following is a summary of a recent ID Journal Club, presented and written by 2nd year ID Fellow Dr. Raj Karnatak: Sepsis defined as “life-threatening organ dysfunction due to the dysregulated host response to an infection” [1]. Sepsis most commonly results from a bacterial infection, or less frequently from a fungal or viral infection. […]

Jan 9, 2019