Antimicrobial Stewardship Program

As much as 50 percent of all antibiotic prescriptions are considered “inappropriate.” Experts consider antibiotics to be “inappropriate” when they are prescribed for non-bacterial infections, the spectrum of coverage is overly broad and potentially toxic, the dose is inaccurate for the host, or the intended duration is too long. “Inappropriateness” contributes directly to medication side effects, interactions, kidney and liver dysfunction, Clostridium difficile infections (CDI), and the emergence of multi-drug resistant pathogens. As early as 1945, Sir Alexander Fleming, the pioneer of the antibiotic era, warned that the overuse of antibiotics “clearly drives the evolution of resistance.”

In 2014 President Obama introduced multi-drug resistance as a national security issue and recognized antimicrobial stewardship as the first line of defense. In 2016, the Centers for Medicare and Medicaid Services and the Joint Commission joined the narrative by emphasizing the need for stewardship across the healthcare continuum (inpatient and ambulatory sites). Mainstream recognition of the scope of antibiotic resistance allows us to implement meaningful solutions. CDC’s “Core Elements of Hospital Antibiotic Stewardship Programs” provide a framework for successful ASP development. These include:

• Leadership Commitment
• Action
• Education
• Accountability
• Tracking
• Drug Expertise
• Reporting

In July 2008, Montefiore Medical Center initiated a multifaceted interdisciplinary stewardship program to educate, support, and advise practicing physicians throughout its extensive Bronx network of hospitals, ambulatory care clinics, and nursing homes. Stewardship operations occur at each of our academic campuses (Moses, Einstein, and Wakefield) and the Children’s Hospital at Montefiore (CHAM). Our strategic stewardship plan is adapted from the Infectious Diseases Society of America (IDSA) guidelines and upholds the CDC’s core stewardship elements to the highest degree. Together with institutional liaisons and stewardship champions, we provide aggregate data on antimicrobial resistance and microbiology, and promote antimicrobial prescribing best practices. Montefiore Einstein Stewardship members have published in the areas of rapid diagnostic technology and stewardship, quality improvement initiatives to improve community acquired pneumonia management, stewardship and Clostridium difficile infection, stewardship and HIV, stewardship in outpatient parenteral antibiotic therapy, carbapenem-resistant Klebsiella and other enterobacteriaceae, medical education in stewardship and infection prevention, and stewardship in special populations.

The Antimicrobial Stewardship Program at Montefiore is featured by the Joint Commission