Virginia Antimicrobial Stewardship Honor Roll

• First within our health system to implement a pharmacist driven antimicrobial stewardship program achieved from a yearlong pharmacy residency project in 2007.
• First within our health system to implement vancomycin and linezolid de-escalation protocol in pneumonia patients utilizing MRSA nasal swabs. Pilot initiated in our ICU 2015 and expanded house wide 2016. Accomplished local MRSA rate reduction from baseline 61% to current 39%.

• Provided education on appropriate use of antibiotics and associated risk of C. difficile infections that resulted in a 39% reduction in fluoroquinolone use.
• Reinforced appropriate allergy assessments to reduce use of broad spectrum aztreonam by 50%.

• Reduced C. difficile infections in the transplant/mechanical circulatory support populations by 50% due to increased diligence with antibiotic use.
• Reduced Ventricular Assist Device drive line infections 100% for the last 2 years due to reduced and targeted antibiotic utilization.
• Implemented changes to preferred antimicrobial prophylaxis regimen for colorectal surgeries and decreased surgical site infections 100% in the subsequent year and continuing.
• Reduced Meropenem prescribing by 33% over a 6-month period.

• Implemented system initiatives resulting in over a 40% decrease in the prescribing of targeted meds for 2017: fluoroquinolones, fluconazole and aztreonam.
• The decrease in fluoroquinolones in particular led to a decrease in Clostridium difficile infections, and an improvement in our sensitivities.
• Implemented a penicillin allergy algorithm to clarify existing system policies around use of aztreonam.

• Partnership between off-site ID pharmacist and on-site clinical pharmacist led to increase in number and acceptance rate of interventions. Optimally treated Community Acquired Pneumonia rates increased by 20% since program implementation.

• Partnership between off-site ID pharmacist and on-site clinical pharmacist led to increase in number and acceptance rate of interventions. Optimally treated Community Acquired Pneumonia rates increased by 20% since program implementation.

• Pharmacist-run penicillin allergy assessment and skin testing service.
• Implementation of a clinical decision order-set for C. difficile infections streamlined first-line use of fidaxomixin.

• Implementation of a clinical decision order-set for C. difficile infections streamlined first-line use of fidaxomixin led to a 43% reduction in recurrence and a 44% decrease in C. difficile related readmission rates.
• Rapid diagnostics and blood culture follow up program implementation led to a significant reduction in time to optimal antimicrobial therapy for all bacteremias. In resistant gram-negative organisms, we demonstrated a reduction in time to optimal therapy from 58 hours to less than 1 day.

• Partnership between off-site ID pharmacist and on-site clinical pharmacist led to increase in number and acceptance rate of interventions. Optimally treated Community Acquired Pneumonia rates increased by 20% since program implementation.

• Partnership between off-site ID pharmacist and on-site clinical pharmacist led to increase in number and acceptance rate of interventions. Optimally treated Community Acquired Pneumonia rates increased by 20% since program implementation.

Pharmacist-run penicillin allergy assessment and skin testing service. Implementation of a clinical decision order-set for C. difficile infections streamlined first-line use of fidaxomixin.

Implementation of a clinical decision order-set for C. difficile infections streamlined first-line use of fidaxomixin led to a 43% reduction in recurrence and a 44% decrease in C. difficile related readmission rates. Rapid diagnostics and blood culture follow up program implementation led to a significant reduction in time to optimal antimicrobial therapy for all bacteremias. In resistant gram-negative organisms, we demonstrated a reduction in time to optimal therapy from 58 hours to less than 1 day.

Partnership between off-site ID pharmacist and on-site clinical pharmacist led to increase in number and acceptance rate of interventions. Optimally treated Community Acquired Pneumonia rates increased by 20% since program implementation.

Partnership between off-site ID pharmacist and on-site clinical pharmacist led to increase in number and acceptance rate of interventions. Optimally treated Community Acquired Pneumonia rates increased by 20% since program implementation.

• Centra’s Antimicrobial Stewardship program began in 2008 on the Long-Term Acute Care (LTAC) Hospital and over the past eleven years has expanded to include all nursing units in Centra’s four hospitals in addition to LTAC. Clinical pharmacists meet with ID physicians and use the prospective audit and feedback method twice weekly to review patient cases meeting predefined diagnostic criteria. These include patients receiving carbapenems, fluroquinolones for UTI, IV antivirals and antifungals, four or more antimicrobials, or other broad-spectrum antibiotics (daptomycin, linezolid, cefepime, colistin, etc.), or patients with complicated disease states such as meningitis, endocarditis, osteomyelitis; or bacteria such as ESBL or CRE producing organisms, staph aureus bacteremia, Acinetobacter, Stenotrophomonas and Burkholderia infections. The program reviews approximately 300 patients annually and has an average recommendation acceptance rate of 96%.
• In addition, the stewardship program also includes clinical pharmacists’ daily review of microbiology data and antimicrobial use for de-escalation opportunities, drug-bug mismatches, renal/pharmacokinetic dosing of antibiotics and IV/PO therapeutic interchange.
• The program implemented numerous infectious disease order sets into the electronic health record. Diagnostic stewardship activities include new two tier testing algorithm for C. difficile, multiplex molecular diagnostic tests for CNS and blood, and the implementation of multiplex PCR in CSF.

• Chesapeake Regional Medical Center (CRMC) has a very engaged Antimicrobial Stewardship Committee (ASC). Monthly meetings include senior leadership, infectious diseases physicians, a hospitalist leader, clinical pharmacy, pharmacy leadership, infection prevention, microbiology, patient safety and quality.
• CRMC enforces a formulary restriction policy and the hospital’s culture encourages providers to optimize the use of broad-spectrum agents.
• Pharmacist rounding in the ICUs has led to reductions in empiric anti-MRSA and anti-pseudomonal beta-lactam therapy on this unit.
• From 2016 to 2018, CRMC successfully reduced fluoroquinolone prescribing by 47% and fluoroquinolone-sparing order sets and physician education have contributed to a reduction in hospital-onset difficile infections.
• CRMC’s ASC has developed protocols to optimize dosing of piperacillin-tazobactam and meropenem and order sets for the treatment of common infections.
• On-going education for clinical staff regarding appropriate antimicrobial use happens via monthly newsletters and bi-monthly webinars.
• CRMC’s program is enhanced by rich collaborations and data sharing with the Centers for Disease Control (CDC), Virginia Department of Health and Duke Antimicrobial Stewardship Outreach Network (DASON). CRMC reports into the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) option and regularly reviews antimicrobial use data.