Genesis of Antibiotic Resistance (AR) XLVII: “Dream Team of Antibiotic Stewardship (DTAS)”

Abstract

Antibiotic Stewardship Programs (“ASP”) have been created to promote optimal use of antibiotics in the acute and chronic infectious disease by effective monitoring and implementation of defined daily dose (DDD), days of therapy (DOT), route of administration, and infection clearance rate. An extensive review of “ASP” policies across the globe exhibit lack of continuity in the chain of command and inadequate elements for a successful “ASP”. We have identified that impediments in the current implementation of “ASP” lacks a clear and coherent chain of communication in terms: a. data availability to the “ASP” team (Emergency Room‐Clinical data on AntiBio gram‐ pharmacy director‐charge nurse‐infection control personal ‐intensive care unit ‐ family involvement‐county‐state‐CDC&P epidemiologist); b. Implementation of isolation protocol for patients with infections lasting more than 7days to limit the spread of infection; c. Implementation of effective informed decision making based on mandatory continuing education on “ASP” in home health care, hospice care, dentistry, nurse practitioners, physician assistants, urgent care, and urgent care /emergency (STAT) dispensaries, and physicians in private practice, education on FDA Adverse Event Reporting System(FAERS); d. Patient education on auto medication, poly pharmacy, drug‐drug reaction, sharing of antibiotics, prevailing trends in infection in the community; e. monitor and rule out the cause of the infection by determining Infection vs. contamination vs. colonization‐ false positive, duration antibiotic therapy (7 days/10 days); f. institution need based specific “ASP” review committee/expertise; g. correlation of meat (Red / White) consumption and clearance of infection by an expert dietician/nutritionist are missing elements. Based on our review here with we propose a “DTAS” constituting the following members: pharmacy director, charge nurse, director of nursing (DON), Clinical Infectious Diseases Director (an MD with expertise in interventions strategies on the infectious diseases expertise across the modality as per the health care setting (Ex: Surgery, Transplant medicine, Oncology, and ICU), director of nutrition/dietician, director of clinical laboratory, director of housekeeping operation, local representative of state health and human services, local representative USDA, hospital epidemiologist, local representative of state and national epidemiology and/or local representative of CDC&P, with an expertise on morbidity and mortality rate of infectious disease and vital statistics data, and community liaison with an expertise in patient education with resource supplemented via health district administration (“Bubble Map”). Taken together, implementation of the DTAS to break the Chain of Infection for Mitigation of Antibiotic Resistance Pandemic (ARP) across the globe in both acute and long term care (Hospice, rehabilitation, dialysis centers, outpatient clinics in the developing countries, physicians in private practice), while plausible “ASP” code enforcement just as the law enforcement agencies would be the pivotal first step to mitigate ARP.Support or Funding InformationSupported by Professional Development Funds provided by SWTJC to Subburaj KannanThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.