About the Antimicrobial Stewardship Program
Antibiotics are essential to effectively treat infections in hospitalized patients; however, 30% of antibiotic use in hospitals is unnecessary or inappropriate. When used incorrectly, antibiotics offer very little benefit to our patients and expose them to risk for adverse events such as C. difficile infections and development of antibiotic-resistant infections. As a response to these challenges, the Johns Hopkins Hospital Antimicrobial Stewardship Program was created in July 2001. Over the past 15 years our program has implemented a number of successful interventions to improve antibiotic use and patient outcomes.
The mission of the program is to insure that every patient at The Johns Hopkins Hospital who needs antimicrobial therapy gets optimal drug choice, dose, duration and route of administration while minimizing resistance development and toxicity.
We are a multidisciplinary group of physicians, pharmacists, and researchers at The Johns Hopkins Hospital, Bayview Medical Center, and Johns Hopkins University with the collective goals of ensuring that all people who need antibiotics receive the most appropriate agent, dose, and duration to optimize cure and minimize side effects and emergence of antimicrobial resistance. We operationalize this goal through three complementary approaches:
- Robust antimicrobial stewardship clinical activities at The Johns Hopkins Hospital (JHH, Adult and Pediatrics) and Johns Hopkins Bayview Medical Center (JHBMC, Adult), and via the JHH/BMC outpatient parenteral antibiotic therapy (OPAT) service.
- A comprehensive research program funded by the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, the Food and Drug Administration, and the National Institutes of Health that seeks to:
- Identify approaches for antimicrobial stewardship interventions across all healthcare settings, including long-term care, ambulatory care and at transitions of care, both domestically and internationally
- Understand risk factors for and outcomes of patients with colonization or infection with resistant Gram-positive and Gram-negative organisms
- Understand optimal antimicrobial treatment approaches for infectious syndromes, including antimicrobial-resistant organisms
- Identify targets for diagnostic stewardship and implement interventions to improve how rapid diagnostics and routine microbiology tests are used in clinical practice
- Identify safe and effective approaches to deliver outpatient parenteral antibiotic therapy to improve the patient experience and minimize adverse events
- Expand data science in antimicrobial stewardship by harnessing data from the electronic health record to drive antimicrobial stewardship efforts at the institution and provider levels and to inform appropriate antimicrobial treatment of patients
- Active and comprehensive mentoring of clinical and research trainees in antimicrobial stewardship and resistance.
The Johns Hopkins Antibiotic Guidelines were developed in 2002 and have been revised and expanded annually. These guidelines are evidenced-based, standardized recommendations tailored to match local susceptibility patterns. Content is developed by our team with input from Hopkins’s faculty content experts from all areas. The guidelines contain information on antimicrobial agents (e.g., indications for use, dosing and monitoring, institution-specific restrictions), microbiology information (e.g., pathogens, rapid diagnostics, antibiograms); and syndrome-specific recommendations (e.g., causative pathogens, recommended therapeutic agents, duration of treatment and management information). Samples of our guidelines are available.
Our Current Research Activities
In addition to promoting optimal antimicrobial use for patients at Johns Hopkins, the JHH Antimicrobial Stewardship Program aims to advance the science in the areas of antimicrobial resistance and stewardship. Out team has many research projects underway, including those listed below.
- Evaluation of approaches to perform antimicrobial stewardship interventions such as prior approval, prospective audit with feedback, and antibiotic time out
- Use of patient safety approaches (e.g, the comprehensive unit-based safety program) in the implementation of antimicrobial stewardship
- Prevent antibiotic overuse (PAUSE)
- Integration of rapid diagnostic testing and antimicrobial stewardship activities
- Evaluation of clinical outcomes associated with antibiotic breakpoint changes in Enterobacteriaceae
- Outcomes associated with different treatment approaches for Enterobacteriaceae bacteremia
- Approaches to surgical antimicrobial prophylaxis
- Oral vs. inhaled ribavirin for the management of RSV in immunocompromised hosts
- Antibiotic management of orthopedic hardware infections
- Use of human factors engineering approaches to improve outcomes of patients receiving outpatient parenteral antibiotic therapy (OPAT)
- Use of human factors engineering approaches to improve cleaning of the hospital environment