Antimicrobial Stewardship in Non-Traditional Settings: A Practical Guide

Description

The evolution of Antimicrobial Resistance is outpacing the ability to create novel antibiotics, which is proving to be a global problem in the fact of climate change, population growth, demographic shifts toward aging populations, emerging infections, and other crises.  Therefore, clinicians are forced to use the existing antimicrobials more responsibly to preserve their longevity for generations to come.  In a parallel vein, there has been a recent regulatory acknowledgement of the importance of prudent antimicrobial prescribing, mandating the implementation of Antimicrobial Stewardship across all healthcare settings.  This is harder to manage in a non-traditional setting, which include long-term care facilities, outpatient care clinics, urgent care centers, and others. Given the trends in patient care in these settings―particularly where the aging community is concerned―this is proving to be a growing problem. This is troublesome even for spaces that have university and large hospital affiliations.   There is a plethora of data describing the implementation and outcomes of Antimicrobial Stewardship Programs in acute-care hospitals with open-access, evidence-based guidelines endorsed by the Infectious Diseases Society of America.  However, non-traditional settings often find themselves struggling to implement the same practices and procedures due to their unique needs and limited resources.  There may be variability in access to resources, applicability, and patient-type.  This book seeks to inform those in non-traditional healthcare settings on the principles, practice, and outcomes of Antimicrobial Stewardship Programs to improve patient care across all settings.   The text begins by unpacking Antimicrobial Stewardship in nontraditional settings then covers specific environments, including long-term care facilities, outpatient clinics, and emergency departments.  The text also covers special topics, including veterinary medicine, HIV, oncology, and immunocompromised patients, pediatrics, neonates, transplant, and critical care patients. Introduction References Contents 1: Antimicrobial Stewardship in Long-Term Care Facilities (Nursing Homes and Rehabilitation Centers) Introduction Antimicrobial Stewardship Programs and Why Your Facility Should Have One Acute Rehabilitation Centers, Sub-Acute Rehabilitation, and Long-Term Care Facilities Existing Guidance Infections in Long-Term Care Facilities and Rehabilitation Centers Steps for Antimicrobial Stewardship Program Implementation in Long-Term Care and Rehabilitation Facilities Step 1: Secure a Commitment Step 2: Create a Committee Step 3: Gather Data Step 4: Identify Areas for Improvement Step 5: Design and Implement Interventions Example Interventions Diagnostic Stewardship and Management Algorithms Urinary Tract Infections Respiratory Tract Infections Antibiotic Utilization Clostridioides Difficile Antibiotic Time-Out Step 6: Measure and Re-Assess Step 7: Educate, Educate, Educate Conclusion References 2: Antimicrobial Stewardship in the Outpatient Setting The Essentials of Stewardship in the Outpatient Setting Primary Care Setting Acute Respiratory Tract Infections Urinary Tract Infections Outpatient Parenteral Antimicrobial Therapy Outpatient Hemodialysis Centers Conclusion References 3: Antibiotic Stewardship in the Emergency Department Introduction Stewardship Priorities Respiratory Tract Infection Diagnosis Treatment Pneumonia Diagnosis Treatment Urinary Tract Infections Diagnosis Treatment Skin and Soft Tissue Infections Diagnosis Treatment Conclusions References 4: Antimicrobial Stewardship in Critical Access Hospitals Introduction Critical Access Hospital Designation Antimicrobial Utilization and Resistance Antimicrobial Stewardship Program Requirements Antimicrobial Stewardship Challenges Solutions and Strategies Conclusion References 5: Antimicrobial Stewardship in Ambulatory Surgery Centers Epidemiology of Surgical Site Infections Principles of Surgical Infection Prophylaxis Timing of Antimicrobial Administration Antimicrobial Agents Dosing of Agent Penicillin Allergy Duration of Antimicrobial Prophylaxis The Role of Microbiological Screening and Decolonization The Role of Antiseptic or Antibiotic Irrigations for Surgical Wounds Clinician Education Principles of Antimicrobial Stewardship References 6: Antimicrobial Stewardship in Canine and Feline Veterinary Medicine Introduction Resistance Prevalence and Shared Flora Between Pets and their Owners Antimicrobial Stewardship Principles and Perceptions in Companion Animal Medicine Current Status of Antimicrobial Stewardship Efforts and Available Guidelines in the USA Urinary Tract Infections (Original Publication in 2011, Updated in 2019) [62, 63] Canine Superficial Bacterial Folliculitis (2014) [67] Antimicrobial Use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats (2017) [68] Summary of Issues Strategies for the Future References 7: Antimicrobial Stewardship in Immunocompromised Hosts Antimicrobial Stewardship in Oncology Antimicrobial Resistance in Oncology Patients Gram Negative Bacterial Resistance in Oncology Gram-Positive Bacterial Resistance in Oncology Preventing Resistance Antimicrobial Stewardship Principles in Oncology Febrile Neutropenia and Antimicrobial Stewardship Antimicrobial Prophylaxis in Oncology Clostridioides Difficile in Oncology Patients Prophylaxis of C. difficile in Oncology Patients The Future of Antimicrobial Stewardship in Oncology and Conclusions Antimicrobial Stewardship in HIV/AIDS Care Antimicrobial Resistance and its Impact on People Living with HIV/AIDS Highlights of Some Antimicrobial Resistant Bacterial Organisms Threats Particularly Relevant to Persons Living with HIV/AIDS Mycobacterium tuberculosis Neisseria gonorrhea Salmonella spp. Streptococcus pneumoniae Antiretroviral Therapy Stewardship Antimicrobial Stewardship Efforts Regarding People Living with HIV/AIDS to Assist in Overall Reduction of Antimicrobial Resistance Antimicrobial Stewardship in HIV/AIDS Care Conclusions Antimicrobial Stewardship in Solid Organ Transplant (SOT) and Hematopoietic Stem Cell Transplant (HSCT) Programs Epidemiology of Antimicrobial Resistance in SOT and HSCT Recipients Antimicrobial Stewardship Challenges in HSCT and SOT Programs Opportunities to Optimize Antimicrobial Therapy for HSCT and SOT: Leveraging Existing Outlines and Frameworks References 8: Antimicrobial Stewardship in the Intensive Care Unit Introduction Components of an ICU Antimicrobial Stewardship Program ASP Intervention(s) Personnel Antibiograms Antimicrobial Therapy Empiric Therapy Altered Pharmacokinetics Pharmacodynamic Optimization Diagnostics Summary References 9: Antimicrobial Stewardship in Pediatric Patients Introduction Pharmacokinetic/Pharmacodynamic Considerations in Pediatrics Prevention Through Vaccination Pediatric-Specific Antibiotic Considerations Protocol Guided Therapy Inpatient Stewardship Metrics Outpatient Stewardship Metrics References 10: Antimicrobial Stewardship in Hospital Networks and Health Care Systems Introduction Atrium Health Ascension Health Intermountain Health Care Kaiser Permanente The Veterans Health Administration Michigan Antibiotic Resistance Reduction Coalition Vizient Future Directions Conclusion References Index