Category: Professional Posters
Antimicrobial stewardship is a program that ensures appropriate infection control and antimicrobial use. It promotes adequate selection, dosing, route of administration and duration of antimicrobial therapy. Antimicrobial stewardship’s primary goal is to optimize clinical outcomes while minimizing unintended consequences. Unintended events include antimicrobials’ side effects, toxicities, and the emergence of resistant microorganisms. Hence, this program improves quality of care, assure patient safety, and reduce health care costs. From January till February 2019, a two-month pilot APPE antimicrobial stewardship rotation was conducted at the Lebanese American University Medical Center in Lebanon, in collaboration with the infectious disease physicians, infection control department, and the pharmacy department. The Lebanese American University School of pharmacy follows a faculty-based model of clinical practice at the university medical center. The activities included: collection and gathering of information on patients receiving non-restricted antimicrobial therapy in all wards of the hospital, optimal empirical and definitive antimicrobial regimen selection (dose, route, and duration), monitoring of laboratory and clinical efficacy and safety parameters for antimicrobials, participating in the discharge plan for patients receiving antimicrobial therapy, recommending appropriate clinical pharmacokinetic monitoring for narrow therapeutic window antimicrobials, counseling patients, recommending IV to PO conversion for antimicrobials, and documentation of clinical interventions for the service. Over this time period, patients on non-restricted antibiotics were followed and monitored for appropriateness of their antimicrobial therapy. A patient list for follow-up was sent daily by e-mail from the hospital pharmacy. Restricted broad-spectrum antimicrobials are followed up by a different team during the infectious diseases APPE rotation. Infectious disease team consult is required for patients who are prescribed restricted antimicrobials for more than 2 days at our institution. A total of 439 patient cases prescribed non-restricted antimicrobials were followed-up and 194 interventions were made. 47 (24%) of these interventions were accepted and 137 (70%) were rejected (the remaining patients were lost to follow up). 54.6% (19 accepted vs 87 rejected) of the interventions were inappropriate antimicrobial choice, dose, and/or duration for surgical prophylaxis followed by antimicrobial duration of therapy (5 accepted vs 15 rejected interventions), and de-escalation of antimicrobials (10 accepted vs 8 rejected interventions), dose adjustments (10 accepted vs 4 rejected). It was an opportunity to show the need to improve the use of non-restricted antimicrobials at our institution albeit with many challenges. The relatively low rate of intervention acceptance could be due to: physician reluctance, lack of awareness for the newly formed antimicrobial stewardship team, and insufficient workforce. Antimicrobial stewardship rotation implementation at our university medical center shed light on areas of improvement that can be promoted by pharmacists for optimal patient care.