Antimicrobial Stewardship in Non-Traditional Settings

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.

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Table of contents :

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