Q&A: Antibiotic Stewardship

Editor's note: The following is an edited Q&A from the HCPro webcast "How to Establish an Antimicrobial Stewardship Program." Speaker Jennifer Pisano, MD, is medical director of the antimicrobial stewardship program at the University of Chicago Medicine and Biological Sciences.

Q: You said an infectious disease (ID) physician is ideal to lead a stewardship program. But not all community hospitals have an ID specialist available or willing to lead a program. Are there any other types of physicians you feel would be able to fill this role?
Pisano: Finding people with energy and interest in filling this role is probably the most important thing. Hospitalist and intensivists are really nice groups of people if there hasn't already been somebody willing to identify themselves as wanting to be part of the [program].

That can be really helpful if their work is already multi-system. They’re working with lots of consultants, a lot of physicians, with the neurologists, and myriad specialty groups, and they already have relationships with them in place. [That] will help you get a look into how the frontline prescribers are using their antibiotics, what issues they're having, and how to implement change.

Q: What were the strategies you thought were most helpful in getting leadership support for your stewardship program, especially in regard to supporting full-time equivalents (FTE) and budgets?
Pisano: We were lucky to have some key members of our leadership group who were interested in stewardship, and we were able to tap into them and solve the program. But I think just making people aware of what we wanted to do, getting good baseline data, showing some improvement with costs, specifically over the first couple years, was very helpful.

It's hard to argue when you say you're saving a significant amount of money, often in the hundreds of thousands, with a successful restriction program if you need another 50% FTE of a physician or pharmacist. So I'd let the data do the walking and talking and see what's important at your institution. If you can tap into what the institutional focus is at that time, you'll make a big, big impact.

Q: How are you able to maintain a high acceptance rate for stewardship intervention?
Pisano: We've been really lucky about that. I've been at this institution for almost 11 years, and I think that's been helpful. I did a large portion of my training here, so I know many of the physicians already. It's not like a new person asking them to take or follow a recommendation.

We're trying to be very mindful about how interventions are implemented and make sure everyone is on board. We never bring an intervention to the table without knowing that the key players are already on board with it. We do a lot of give and take.

We've done a lot for the surgeons here, which has been a really nice thing because I think in some places that's been difficult. They have their protocols, and it's hard to break in and make big changes. But with data, it can be very helpful. Through collaborations with our infection control [department], we were able to run lists of postop infections and what people were seeing with different surgical subspecialty areas. Then we'd report back to these areas, taking into account what kind of perioperative antibiotics they were using, [then] making some changes and doing another set of data collection once changes were made. Often we saw some decreases in infection.

So, you do a few small projects like that with each group, you build trust with them, and you follow up on the recommendations. Make it clear you think they're important, have data, and care about their patients, and people in general will be very happy and accepting to have your input. Often you'll call up a physician and say, "Hey, you discharged this patient. It doesn't look like the susceptibilities are back yet. You want to change that now?" They're very thankful that you called them to help out with that. It's a give and take, but it's worth it.

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