The optimal method of controlling antimicrobial use in hospitals is unknown. The most common approach is to require pre-approval for restricted antimicrobial agents before they are dispensed. A second approach is to review antimicrobial orders for selected agents 48-72 hours after the first dose at which time additional clinical and microbiological data are available for making evidence-based recommendations. The aim of this project is to study of the effectiveness of an intervention practice of reviewing and making recommendations about antimicrobial use 48 hours into therapy compared with existing baseline antimicrobial use practices such as unrestricted use or pre-approval for certain agents. Study antimicrobials are the following classes of broad-spectrum agents: vancomycin (oral and parenteral), beta-lactam/beta-lactamase inhibitors (parenteral only), fluoroquinolones (oral and parenteral), carbapenems, and third and fourth generation cephalosporins. The primary outcomes measures will be mean days of receipt of the study antimicrobials, and mean days of receipt of all antimicrobials per study patient. Secondary outcomes will be length of hospital stay and in-hospital mortality. Descriptive data will include the frequency and situations of use of the study antimicrobials when not clearly justified. Evaluation of the Effectiveness of Antimicrobial Management Based on Review of Therapy After 48 Hours
PI: Trish M. Perl, M.D., M.Sc.
Sponsor: Centers for Disease Control and Prevention (CDC) This project is a CDC – Epicenters of Excellence, multi-center study, coordinated by Johns Hopkins University. Patients on specific units are monitored for antibiotic use. After 48 hours, the orders for these antimicrobials are reviewed. If the reasons for the use of that particular antibiotic are not apparent or it appears that a more appropriate choice of antibiotic could be made, an attempt is made to contact the patient’s physician. If it is determined at that point that an antimicrobial agent is being used inappropriately, recommendations will be made to either discontinue treatment or to change the treatment to include more appropriate antimicrobials. Either way, the patients are then followed to determine subsequent antibiotic usage and outcomes of their stay. Evaluation of Different Methods of Provider Feedback Regarding Antimicrobial Use
PI: Sara Cosgrove, M.D., M.S.
Sponsor: Centers for Disease Control and Prevention (CDC) As in the project above, Evaluation of the Effectiveness of Antimicrobial Management Based on Review of Therapy After 48 Hours, patients on specific units are monitored for antibiotic use. After48 hours, the orders for these antimicrobials are reviewed. If the reasons for the use of that particular antibiotic are not apparent, or it appears that a more appropriate choice of antibiotic could be made, an attempt is made to contact the patient’s physician. The difference between these two studies is here: In this study, the treating teams will be contacted by phone, text message or written message (attached to the patient’s chart). The mode of contact is determined by nursing unit. The primary outcome for this study is the percentage of recommendations followed for each type of intervention. When the data collection for this part of the study is complete, a survey of physicians on these units is planned to see if they have been contacted by study personnel in conjunction with the study, what type of contact was made (phone, text message or written message) and which type of communication they preferred. For more information on these studies please email Kathleen Speck or contact her at (410) 614-6206. | 
