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Antibiotic Stewardship GUIDELINES Pocket Card

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Infectious Diseases Society of America

Society for Healthcare Epidemiology of America

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The Antibiotic Stewardship GUIDELINES Pocket Card is based on the latest guidelines of the Infectious Diseases Society of America (IDSA) and was developed with their collaboration. This practical quick-reference tool contains graded recommendations for instituting and optimizing stewardship programs to assure the most effective and enduring use of antibiotics in healthcare settings.

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4.25″ x 7

Background
Interventions
Optimization
Microbiology and Laboratory Diagnostics
Measurement
Special Populations
Table

Comparison of Preauthorization and Prospective Audit and Feedback Strategies for Antibiotic Stewardship

The Infectious Diseases Society of America (IDSA) represents physicians, scientists and other health care professionals who specialize in infectious diseases. IDSA's purpose is to improve the health of individuals, communities, and society by promoting excellence in patient care, education, research, public health, and prevention relating to infectious diseases.

SHEA is dedicated to advancing the science and practice of healthcare epidemiology and preventing and controlling morbidity, mortality, and the cost of care linked to healthcare-associated infections. The society partners with epidemiologists, infectious disease practitioners, basic scientists, public health specialists, consumers, policymakers, and others, to achieve better healthcare outcomes.

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Antibiotic Stewardship GUIDELINES Pocket Card

Approved By

Infectious Diseases Society of America

Society for Healthcare Epidemiology of America

$6.99 Digital
$9.95 Print

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Background

Approaches to optimize the use of both existing antibiotics and newly developed antibiotics are of critical importance to ensure that we continue to reap their benefits and provide the best care to patients.
Antibiotic stewardship has been defined as “coordinated interventions designed to improve and measure the appropriate use of antibiotic agents by promoting the selection of the optimal antibiotic drug regimen including dosing, duration of therapy, and route of administration.”
The benefits of antibiotic stewardship include improved patient outcomes, reduced adverse events including Clostridium difficile infection (CDI), improvement in rates of antibiotic susceptibilities to targeted antibiotics, and optimization of resource utilization across the continuum of care.
IDSA and SHEA strongly believe that antibiotic stewardship programs are best led by infectious disease physicians with additional stewardship training.

Interventions

We recommend preauthorization and/or prospective audit and feedback over no such interventions (See Table 1) (S-M).
- Preauthorization and/or prospective audit and feedback improve antibiotic use and are a core component of any stewardship program. Programs should decide whether to include one or a combination of both strategies based on the availability of facility-specific resources for consistent implementation, but some implementation is essential.
We suggest against relying solely on didactic educational materials for stewardship (W-L).
- Passive educational activities, such as lectures or informational pamphlets, should be used to complement other stewardship activities. Academic medical centers and teaching hospitals should integrate education on fundamental antibiotic stewardship principles into their preclinical and clinical curricula.
We suggest antibiotic stewardship programs (ASPs) develop facility-specific clinical practice guidelines coupled with a dissemination and implementation strategy (W-L).
- Facility-specific clinical practice guidelines and algorithms can be an effective way to standardize prescribing practices based on local epidemiology. ASPs should be involved in writing clinical pathways, guidelines, and order sets that address antibiotic use and are developed within other departments at their facility.
We suggest ASPs implement interventions to improve antibiotic use and clinical outcomes that target patients with specific infectious diseases syndromes (W-L).
- ASP interventions for patients with specific infectious diseases syndromes—such as community-acquired pneumonia, skin and soft tissue infection, and urinary tract infection—can be an effective way to improve prescribing because the message can be focused, clinical guidelines and algorithms reinforced, and sustainability improved.
We recommend antibiotic stewardship interventions designed to reduce the use of antibiotics associated with a high risk of Clostridium difficile infection, compared with no such intervention (S-M).
- The goal of reducing CDI is a high priority for all ASPs and should be taken into consideration when crafting stewardship interventions.
We suggest the use of strategies (e.g., antibiotic time-outs, stop orders) to encourage prescribers to perform routine review of antibiotic regimens to improve antibiotic prescribing (W-L).
- Successful prescriber-led programs appear to require a methodology that includes persuasive or enforced prompting.
We suggest incorporation of computerized clinical decision support at the time of prescribing into ASPs (W-M).
- Computerized clinical decision support for prescribers should only be implemented if information technology (IT) resources are readily available. However, computerized surveillance systems can streamline the work of ASPs by identifying opportunities for interventions.
We suggest against the use of antibiotic cycling as a stewardship strategy (W-L).

Table 1. Comparison of Preauthorization and Prospective Audit and Feedback Strategies for Antibiotic Stewardship

Advantages
Preauthorization	Reduces initiation of unnecessary/ inappropriate antibiotics Optimizes empiric choices and influences downstream use Prompts review of clinical data/ prior cultures at the time of initiation of therapy Decreases antibiotic costs, including those due to high-cost agents Provides mechanism for rapid response to antibiotic shortages Direct control over antibiotic use
Prospective Audit and Feedback	Can increase visibility of ASP and build collegial relationships More clinical data available for recommendations, enhancing uptake by prescribers Greater flexibility in timing of recommendations Can be done on less than daily basis if resources are limited Provides educational benefit to clinicians Prescriber autonomy maintained Can address de-escalation of antibiotics and duration of therapy

Disadvantages
Preauthorization	Impacts use of restricted agents only Addresses empiric use to a much greater degree than downstream use Loss of prescriber autonomy May delay therapy Effectiveness depends on skill of approver Real-time resource intensive Potential for manipulation of system (e.g., presenting request in a biased manner to gain approval) May simply shift to other antibiotic agents and select for different antibiotic-resistance patterns
Prospective Audit and Feedback	Compliance voluntary Typically labor-intensive Success depends on delivery method of feedback to prescribers Prescribers may be reluctant to change therapy if patient is doing well Identification of interventions may require information technology support and/or purchase of computerized surveillance systems May take longer to achieve reductions in targeted antibiotic use

Disadvantages

Preauthorization

Impacts use of restricted agents only
Addresses empiric use to a much greater degree than downstream use
Loss of prescriber autonomy
May delay therapy
Effectiveness depends on skill of approver
Real-time resource intensive
Potential for manipulation of system
(e.g., presenting request in a biased manner to gain approval)
May simply shift to other antibiotic agents and select for different antibiotic-resistance patterns

Prospective Audit and Feedback

Compliance voluntary
Typically labor-intensive
Success depends on delivery method of feedback to prescribers
Prescribers may be reluctant to change therapy if patient is doing well
Identification of interventions may require information technology support and/or purchase of computerized surveillance systems
May take longer to achieve reductions in targeted antibiotic use

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Antibiotic Stewardship GUIDELINES Pocket Card

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Background

Interventions

Table 1. Comparison of Preauthorization and Prospective Audit and Feedback Strategies for Antibiotic Stewardship

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