How to Create Institution-Specific Antibiotic Stewardship Interventions

Contagion^® Editorial Advisory Board member, James S. Lewis, PharmD, FIDSA, Co-Director of Antibiotic Stewardship, Oregon Health and Science University, shares how antibiotic stewards can craft stewardship interventions to their own reality.

Interview Transcript (modified slightly for readability):

The definition of “crafting [antibiotic] stewardship interventions to your own reality” is really built around, how you take the data from your institution [and] your daily practice and apply that to your antibiotic stewardship interventions. To customize recommendations that are made in national guidelines [and] alter them in such a way that they fit better with the data that you have available at your institution.

The fact that the guidelines are national is both a strength and a weakness. [They] tend to be evidence-based and written by experts in the field; however, the recommendations tend to be subject to information that is available in the literature and the opinions of those experts. Furthermore, those experts are often in clinical settings that may not look anything like the day-to-day setting that you [as a provider] are practicing in, and so I think it is important that stewards understand that there are comments in those guidelines that allow and encourage flexibility and alteration of some of the recommendations. You need to use the data at your institution to guide these alterations.

The most powerful piece of data that’s readily available to stewards to do craft their antibiotic stewardship program to their setting is their institutional antibiogram. [Then] they can take that institutional antibiogram and cut it by patient type, and type of service area (such as intensive care unit versus medical floor versus surgery floor) where you may see differences in the bacteria that are commonly found in those patients, and where you may also see substantial differences in the susceptibilities between those different patient types and different patient locations.

That’s really an area that I think is underutilized by antibiotic stewards and I think there is a real underappreciation for the flexibility comments that are buried within these, oftentimes, very large national guideline documents.