John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois

WHO – ID Physicians and Pharmacists David Schwartz, MD Chairman, Division of Infectious Diseases Over-sight of AMS activities Identifying stewardship opportunities through surveillance activities, anecdotal experiences Organizing and implementing stewardship activities Developing resources to support AMS staff -Guidelines -Shortages Monitoring effects of ASP activities Back-up for front-line ASP staff (uncertainties surrounding antibiotic use) Becca Peglow, MD 3 rd year ID Fellow, Antimicrobial Stewardship Gail Itokazu, PharmD Robert Glowacki, PharmD Clinical Pharmacists (Medical/surgical wards, ICUs) Katayoun Rezai, MD Attending, ID Director, Outpatient Antimicrobial Therapy Program (OPAT) Back-up for AMS staff ID-MD FellowsBacteremia surveillance Back-up for AMS staff

ASP Activities: Institutional Guidelines What Empiric treatment of common infection syndromes Diagnosis, Drug, Dose, Duration, De-escalation Why Request from Internal Medicine attending, “How to treat common infections” Where Hospital-wide Readily accessible via the electronic medical record When present

ASP Activities: Antimicrobial use in diabetic foot infections (DFIs) What Educational intervention Why Excessively broad-spectrum abx often prescribed - MSSA, Group B strep common* - piperacillin/tazobactam plus vancomycin rx Practice is hard to change Where Family Medicine Service When 2011 – present …..ICHASE *deep wound cultures obtain by Podiatry Service

5 Illinois Collaborative for Hospital Antimicrobial Stewardship Enhancement (ICHASE) Collaboration CDC, IDPH and 5 other hospitals in Illinois to improve Antimicrobial stewardship Educational Intervention – Empower clinicians with the knowledge to manage abx for DFIs – Lecture series by ID-MD Fellow and Family Medicine Resident – Institutional guideline use

6 Look in chart for previous culture data to help guide empiric therapy

7 Preliminary findings…. Pre-intervention (n=37)Post-intervention (n=26) Guideline adherence*13 (35%)16 (62%) Acceptance of recommendations 19 (95%)15 (100%) DOT / 100 patient days Piperacillin/tazobactam6531 Vancomycin5348 Ampicillin/sulbactam3268 * Initiation of guideline recommended empiric therapy by targeted service; data represents 2 months of surveillance in 2012 and 2014.

8 Lessons Targeted educational intervention – improved adherence to institutional guideline for the initial selection of antimicrobials Clinician buy-in and involvement during the planning of the intervention Longer term effect of intervention needs to be evaulated

9 Next steps Vascular /Podiatry services – Better utilization of resources – Decrease length of stay – Optimizing antibiotic utilization Assess the clinical and economic outcomes of continued audit and feedback by Physician Assistant