Specific Goals & Expectations 

Infectious Diseases Antibiotic Stewardship Program

Modern infections disease practice requires an integrated quantitative and qualitative awareness of anti-infective usage and resistance patterns.  Trends in antibiotic usage and transmission of infection also inform antibiotic stewarship. 

 

Goals:  To provide Fellows experience in evaluating and managing anti-infective therapy to achieve key goals:  1) optimize efficacy of antimicrobial therapy; 2) minimize emergence of resistance; and 3) maintain the most cost-effective use of the anti-infective formulary.  Fellow responsibilities will include the overall management of at-risk, acute and symptomatic, as well as chronic and asymptomatic infections.  A central objective of this clinical experience is to work with the Microbiology laboratory to define the most efficacious regimen versus a given organism or infecting strain, mindful of all relevant issues pertaining to antimicrobial resistance.  The Fellow will also acquire experience in considering ethical issues related to infection, including confidentiality, reportability, appropriate notification to minimize transmission, hospice options, conservatorships, and non- resuscitation orders. The fellow will also help lead treatment of outpatients on home IV antibiotic therapy (OPAT) and help supervise monitoring of their therapy and the safety of this treatment. Finally, an integral role of the Fellow will be to supervise and instruct Residents and Medical Students in the most efficacious and cost-effective therapy of infections in adults.  These goals are designed to address the six competencies outlined by the RRC / ACGME.

 

Format:  The Adult ID Fellow will carry the antibiotic approval beeper, and reply in a timely manner to queries for antibiotic use and approval.  The Fellow will do so under supervision of an attending Faculty member in the adult ID service setting.  In this role, Fellows are required to communicate professionally with a diverse array of subspecialty services, including Surgery, Orthopedics, Oncology, and supportive resources including Microbiology, Pathology, and Pharmacy.  In addition, the Fellow will consult with the ID Pharmacist whenever possible.  The Fellow will carry and respond to the antibiotic approval beeper during normal service hours, with the following schedule to ensure adherence to RRC / ACGME duty hour guidance:  1) during ward rounds with Attending(s), the Bridge Fellow will hold and respond to antibiotic approval beeper; 2) from 10pm—7am, an appropriate Fellow will be available to respond to questions / consults beyond the Automatic Antibiotic Approval (AAA) Program.  The AAA program defines a pre-approved anti-infective formulary between 10pm—7am.  It should be noted that the adult ID Fellow is expected to promptly resume antibiotic approval at 7am, and review and revise as appropriate any antibiotic regimens administered in prior 10pm to 7am periods. 

 

A key part of the Antibiotic Stewardship Program is the availability of ID-dedicated Antibiotic Pharmacists to assist the Fellows regarding key issues of antimicrobial usage, efficacy, resistance monitoring, adverse events, drug-drug interactions and streamlining of basic strategies regarding formulary and cost-effectiveness.  These individuals also participate in the core educational goals of the ID-HIV Residents, including didactic seminars and clinical bedside teaching.