Infectious Diseases II

use, which include the emergence of antimicrobial resistance and adverse drug reactions. In addition, a

responsible approach to the use of antimicrobial agents should reduce the overall costs associated with

treatment.

Antibiotics are the second most common class of drugs that cause adverse effects.

Minimizing antimicrobial resistance by optimizing therapy should lead to measurable benefits at the

patient level because studies have shown the negative effect of antimicrobial resistance on several

clinical outcomes.

Effective January 2017, TJC announced a new medication management standard that addresses

antimicrobial stewardship. Many of the standards are applicable and relevant to critical care

pharmacists: continuing education of staff, education of patients and family members, participation

in an antimicrobial stewardship team, and development and execution of antimicrobial management

protocols.

In 2018, CMS finalized a rule that requires all acute care hospitals participating in Medicaid/Medicare

services to implement antibiotic stewardship programs (ASPs). In 2022, additional requirements were

recommended including organization and policies for infection prevention and control programs and

ASPs, leadership responsibilities, and unified and integrated infection prevention and control programs

and ASPs for multi-hospital systems.

In 2019, the CDC updated the hospital core elements to reflect the new evidence in the field of antibiotic

stewardship. Major updates include hospital leadership commitment, accountability, pharmacy

expertise, tracking, reporting, and education. In 2023, TJC published new and revised elements of

performance that address antibiotic stewardship. New elements of performance include allocation of

financial resources for staffing and information technology to support the ASP, the requirement that

ASPs monitor the hospital’s antibiotic use by analyzing data on days of therapy per 1000 days present or

1000 patient-days, the recommendation that ASPs implement preauthorization for specific antibiotics

and/or prospective review and feedback regarding antibiotic prescribing practices, the recommendation

that ASPs implement at least 2 evidence-based guidelines to improve antibiotic use (e.g., community-

acquired pneumonia, skin and soft tissue infections), and the recommendation that ASPs evaluate

adherence to at least 1 of the evidence-based guidelines that the hospital implements.

measure the appropriate use of antimicrobial agents and to promote the selection of optimal antimicrobial

drug regimen, including dosing, duration, and route of administration.

Core members of a multidisciplinary antimicrobial stewardship team should include an infectious

diseases physician, a clinical pharmacist, a clinical microbiologist, an information systems specialist,

an infection control professional, a nurse, and a hospital epidemiologist.

However, continued use of broad-spectrum antimicrobials may lead to the selection of pathogenic

organisms (i.e., C. difficile, Candida spp.), nephrotoxicity, and the emergence of resistance.

expedited selection of appropriate initial agents, aggressive dosing to optimize PD, interpretation of

microbiological evidence, appropriate de-escalation of antimicrobials, monitoring of response and potential

adverse effects, and determination of the appropriate treatment duration