CME/CE: Guidance on Implementing Antibiotic Stewardship

CME/CE: Guidance on Implementing Antibiotic Stewardship

As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria, hospitals and healthcare systems have been called upon by the White House to implement antibiotic stewardship programs by 2020. The goal of the plan is to ensure the appropriate use of antibiotics and reduce the growing emergence of resistance. A previous guideline on antibiotic stewardship was released in 2007 and focused on the development of programs rather than on specific evidence-based strategies that have been shown to be beneficial in ensuring that such programs are effective and sustainable. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have recently published a new guideline in Clinical Infectious Diseases that emphasizes the use of various interventions depending on local resources, issues, and expertise.   The Foundation In total, IDSA and SHEA issued 28 recommendations in the new guideline. All of these recommendations stand on their own, complete with a section of literature that supports the recommendation. The guideline was based on a review of hundreds of  stewardship-focused papers that examined different strategies, “We included new studies as much as possible,” says Tamar Barlam, MD, who co-authored the update with Sara Cosgrove, MD. “For example, several recent studies show that a shorter course of antibiotics appears to be just as effective as a longer course,” she says. “A shorter but equally effective course would theoretically provide less opportunity for side effects or the emergence of resistance.” Dr. Barlam notes that the IDSA/SHEA writing committee started with a recommendation they feel should be the first step in running an antibiotic stewardship program. “Pre-authorization, prospective audit and...
Guidance on Implementing Antibiotic Stewardship

Guidance on Implementing Antibiotic Stewardship

As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria, hospitals and healthcare systems have been called upon by the White House to implement antibiotic stewardship programs by 2020. The goal of the plan is to ensure the appropriate use of antibiotics and reduce the growing emergence of resistance. A previous guideline on antibiotic stewardship was released in 2007 and focused on the development of programs rather than on specific evidence-based strategies that have been shown to be beneficial in ensuring that such programs are effective and sustainable. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have recently published a new guideline in Clinical Infectious Diseases that emphasizes the use of various interventions depending on local resources, issues, and expertise.   The Foundation In total, IDSA and SHEA issued 28 recommendations in the new guideline. All of these recommendations stand on their own, complete with a section of literature that supports the recommendation. The guideline was based on a review of hundreds of  stewardship-focused papers that examined different strategies, “We included new studies as much as possible,” says Tamar Barlam, MD, who co-authored the update with Sara Cosgrove, MD. “For example, several recent studies show that a shorter course of antibiotics appears to be just as effective as a longer course,” she says. “A shorter but equally effective course would theoretically provide less opportunity for side effects or the emergence of resistance.” Dr. Barlam notes that the IDSA/SHEA writing committee started with a recommendation they feel should be the first step in running an antibiotic stewardship program. “Pre-authorization, prospective audit and...
Managing Candidiasis: Updated Guidelines

Managing Candidiasis: Updated Guidelines

The Infectious Diseases Society of America (IDSA) last updated their guideline on the management of candidiasis in 2009. Since that time, new data have emerged on the diagnosis, prevention, and treatment of this major cause of morbidity and mortality, leading to an update to IDSA’s recommendations that was recently released. “Among the most important studies during this time were those that assessed first-line therapy with echinocandins versus azoles,” says Peter G. Pappas, MD, lead author of the guideline update. This new research shows that echinocandins—which kill the fungus—are more effective than azoles—which prevent the fungus from growing—in treating invasive infections. “The data support our key recommendation to start most patients with candidiasis on echinocandins and then step down to an azole.” Judicious Prophylaxis The updated guideline also addresses the importance of judiciously using prophylaxis. It is important to understand which patient populations are mostly likely to benefit from prophylaxis, including ICU patients and transplant recipients. ICU patients who stand to benefit most from prophylaxis include patients: Who have been on antibiotics. Have central venous catheters. Are on a ventilator. Have pancreatitis or recent abdominal surgery. Are immunosuppressed. Have skin burns. “Transplant patients who would benefit most from prophylaxis include high-risk liver transplant recipients, those with modified renal function, and those with prolonged operations who require blood products,” adds Dr. Pappas. Clinicians are also advised to suspect candidiasis in patients who are deteriorating without an obvious reason, have unexplained fever, and have elevated white blood cell counts.   The Importance of Early Care A key theme throughout the guideline update is the importance of early recognition and initiation of therapy...
Progress Elusive for New Antibiotics

Progress Elusive for New Antibiotics

There has been a desperate need for new antibiotics to treat infections caused by multidrug-resistant gram-negative bacilli (GNB) bacteria. In 2010, the Infectious Diseases Society of America (IDSA) launched its 10 x ’20 Initiative, which established a goal to develop 10 new systemic drugs to treat infections caused by resistant GNB bacteria by 2020. Unfortunately, there are still many barriers to the approval of these needed additional antibiotics, and it’s highly unlikely that these new drugs will be developed by 2020. Accelerated Efforts on Antibiotic Development Needed According to recent data, only seven new drugs are currently in development for the treatment of infections caused by GNB bacteria. Since the IDSA’s 10 x ’20 Initiative, only one new systemic antibiotic has been approved. There is also no guarantee that the drugs currently in development will actually gain FDA approval or will work against the most resistant bugs. While some progress has been made, ground is still being lost because new drugs aren’t being developed quickly enough to keep pace with antibiotic resistance.   At this time of greatest need, the number of pharmaceutical companies investing in antibiotic research and development (R&D) has decreased substantially. Only four multinational pharmaceutical companies have engaged in antibacterial discovery. R&D resources are typically strongest for developing drugs for chronic disease like high cholesterol, diabetes, and cancer. These drugs can provide significant financial rewards, partly because they’re intended for use for long periods of time. Antibiotics are a different story because they’re intended to be taken for shorter courses. This has made it less appealing for the pharmaceutical industry to use R&D resources for such...
Guideline Recommendations for Prosthetic Joint Infections

Guideline Recommendations for Prosthetic Joint Infections

Research shows that as many as 20,000 of the nearly 1 million total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed in the United States result in a prosthetic joint infection (PJI) over the lifetime of the device. PJIs remain one of the most serious complications of prosthetic joint implantation. According to recent estimates, roughly 4 million THAs and TKAs will be performed each year in the U.S. by 2030, due largely to the rapidly increasing elderly population. Diagnosing PJIs is often challenging for physicians and frequently necessitates multiple modalities. Management of these infections typically requires surgical interventions and lengthy courses of intravenous (IV) and oral antibiotics. Although much research has been conducted in this area, questions about optimal diagnosis and management strategies for PJIs remain. The Infectious Diseases Society of America (IDSA) recently released updated guidelines that are intended to help clinicians by offering optimal strategies to improve the diagnosis and management of these infections. Using a Team Approach A key point that the IDSA guidelines emphasize is that using a multidisciplinary team approach is essential for managing PJIs. “A strong collaboration is required from all medical specialists who are involved in the care of patients with PJIs,” explains Douglas R. Osmon, MD, who served as lead author of the IDSA guidelines. “This team most often includes an orthopedist and an infectious diseases specialist. Other specialists should be involved on a case-by-case basis, such as plastic surgeons, general internists, nurses, mid-level providers, and microbiologists.”   Patients requiring THA or TKA procedures tend to be elderly, meaning they are more likely than others to have multiple comorbidities,...
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