Table 1. Publications About Medical Trainees’ Involvement in Antimicrobial Stewardship Efforts15–18 Study


Settinga


Foral et al15 2 academic medical centers


Level of Traineeb


ID fellow, medical resident, medical student, pharmacy resident, APPE pharmacy student


Lee et al16


Academic medical center (2 internal medicine units)


Yeo et al17


Academic medical center


(hematology/ oncology patients)


Rimawi et al18


Academic medical center (medical ICU)


ID fellow Medical resident AS Strategy/ Strategies Employed


Prospective audit with intervention and feedback; dose optimization; education; streamlining/ de-escalation of therapy; IV to PO conversion


Prospective audit with intervention and feedback; dose optimization; education; streamlining/ de-escalation of therapy


AS-Related Intervention Details


Educational seminars to admitting teams; the trainees completed a monitoring form of identified patients receiving antimicrobials. The trainees discussed each case and possible interventions during daily multidisciplinary AS rounds. Trainees used motivational interviewing to help convey recommendations to the primary medical teams.


Senior medical residents on the admitting team reviewed/audited patients receiving carbapenems, moxifloxacin, piperacillin/ tazobactam, or vancomycin twice per week using a checklist. The residents were educated prior to the intervention by ID-trained specialists.


ID fellow


Prospective audit with intervention and feedback; dose optimization; streamlining/de-escalation of therapy; IV to PO conversion


Prospective audit with intervention and feedback; education; streamlining/de-escalation of therapy; IV to PO conversion


ID Fellow plus ID pharmacist-run AS program instead of ID attending plus ID pharmacist-run program


Outcomes (If Applicable)


2,266 interventions were made with 90.5% acceptance rate by primary team over a 2-y period


80% audit adherence rate involving 679 patients. There was a change in therapy in approximately 15% of the audits. One year antibiotic cost savings of $69,424 (46% cost reduction). Significant decrease in use of moxifloxacin, but no difference in antibiotic use overall. Also significant decrease in C. difficile infection rates.


During year of fellow-led AS program: 14.8% fewer AS recommendations made, 14.4% lower recommendation acceptance rate, and higher use of all IV antibiotics, including carbapenems, third and fourth generation cephalosporins, piperacillin/ tazobactam, and vancomycin


ID fellow reviewed charts of all MICU patients receiving antimicrobials daily. ID attending was available for discussion of complex cases. ID fellow met with MICU attending, critical-care fellow, and critical-care pharmacist to discuss recommendations.


In 3-mo intervention period, there were: significant reductions in the use of piperacillin-tazobactam carbapenems, vancomycin, linezolid, and metronidazole, a 25% increase in compliance with national guidelines, decrease in antibiotic costs ($22,486), and significant decreases in days of mechanical ventilation and MICU length of stay.


Note. AS, antimicrobial stewardship; ID, infectious diseases; APPE, advanced pharmacy practice experience; IV, intravenous; PO, enteral route; ICU, intensive care unit; MICU, medical intensive care unit aAcademic medical center, community hospital, long-term care, etc. bStudent, resident, fellow.


202


Lindsey M. Childs-Kean et al


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156