Category: Antimicrobial Stewardship

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

Technology vs. Humans: Role of Rapid Diagnostics and Antimicrobial Stewardship in Cancer Patients

Rapid diagnostic testing (RDTs) plays an important role in Antimicrobial Stewardship Programs (ASP) and highlights the impact of the Microbiology laboratory on reducing inappropriate antibiotic use, particularly in hospitalized patients. Early microbial identification with RDTs can lead to earlier initiation of targeted antimicrobial therapy, which can in turn result in shorter hospitalization, fewer adverse events […]

Jan 3, 2019

Bacteriocidal versus Bacteriostatic: What Makes the Biggest Difference in VRE Bloodstream Infection?

An October 2018 publication in Critical Care Medicine by Chuang et al details a prospective study of adults in Taiwan, between 2010 -2015, aimed to assess all-cause mortality and rate of bloodstream clearance among patients with vancomycin-resistant enterococci (VRE) treated with daptomycin (bacteriocidal) versus linezolid(bacteriostatic). Patients were treated with conventional daptomycin (6 to < 9 mg/kg […]

Dec 19, 2018

Skin Deep: A Closer Look at Treatment of Skin and Soft Tissue Infections

Current guidelines for management of Skin/Soft Tissue Infections (SSTIs) were published in 20141.  Nevertheless, management of SSTIs is variable, likely driven by the fact that culture data is often unavailable to direct clinical decision making. Treatment variability results in inappropriate antimicrobial use, highlighting the need for antimicrobial stewardship. Consequently, management of SSTIs is one area […]

Dec 3, 2018

UNMC Infectious Diseases Fellows are Antibiotics Aware

The following was written by Dr. Raj Karnatak, 2nd year ID fellow at UNMC; a reflection of his current Antimicrobial Stewardship/Infection Control rotation: The UNMC Infectious Diseases fellowship antimicrobial stewardship and infection control rotation provides robust training for fellows in both antimicrobial stewardship and infection control. Training is well designed with education in all the […]

Nov 16, 2018

How Nebraska ASAP is Making Everyone Antibiotic Aware

The following was written by Dr. Salman Ashraf, co-Medical Director of the Nebraska Antimicrobial Stewardship Assessment & Promotion Program (ASAP): Antibiotic Resistance is one of the most urgent threats to the public health. Overuse and misuse of antibiotics allows the development of antibiotic-resistant bacteria. Unfortunately, a significant proportion of antibiotic use in various healthcare settings […]

Nov 15, 2018