Infectious Diseases II

focused only on antimicrobial costs, with little focus devoted to indirect costs and implementation costs.

There is currently a proposed CMS rule for incorporating antibiotic prescribing patterns as one of

the quality-reporting metrics. Many CMS quality metrics are tied to reimbursement. If this metric

becomes tied to reimbursement, there will be further incentives to implement antimicrobial stewardship

programs.

Evidence Supporting Antibiotic Stewardship Efforts in Critically Ill Patients

Studies in this area have been limited by poor study design. However, most studies have reported a

decreased use in either antibiotics overall or a targeted class of antibiotics. Some studies have also

reported a decrease in key resistance rates.

infectious disease physician consultation, protocols for de-escalation, implementation of computer-

assisted decision support, and formal reassessments of the empiric antibiotics by a stewardship team.

Meta-analyses of before-after studies evaluating prospective audit and feedback of ICU patients

receiving antibiotics found no increase in mortality, suggesting that this practice could safely be

implemented in critically ill patients.

There is an association between delay in administration of appropriate antimicrobials and decreased

survival among patients with septic shock.

pathogens are covered.

Rapid diagnostic tests may assist in de-escalation efforts in an attempt to practice antibiotic stewardship.

Critical care pharmacists are advocates for the appropriate use of antimicrobials according to the results

of rapid diagnostic tests.

In many cases, the implementation of rapid diagnostic tests may be cost neutral, or even constitute a cost

savings, when antimicrobial stewardship efforts leading to decreased consumption of antibiotics occur.

Recommended by IDSA antibiotic stewardship guidelines to be used in combination with stewardship

team to optimize antibiotic therapy and improve clinical outcomes

The Society of Infectious Diseases Pharmacists released an official position statement stating that

rapid diagnostic tests can help antimicrobial stewardship programs decrease unnecessary exposure and

optimize patient care.

All discussed methods attempt to shorten the time from blood culture positivity to species identification

or susceptibility testing. Traditional pathogen identification and susceptibility testing can take 72–96

hours. Early pathogen identification techniques seek to provide clinically actionable information within

the first 24 hours from the time of culture positivity. See Table 5 for examples of rapid diagnostic tests,

corresponding targets, and respective turnaround times.