A Focus on Antimicrobial Stewardship
Bacterial infections, both in and outside the hospital, continue to cause significant illness, and even death in our society. Of particular concern is the emergence of bacteria resistant to many and sometimes all of the currently available antibiotics. Antimicrobial stewardship is the practice of optimizing the use of anti-infectives (e.g. antibiotics, antifungals) with the hope of preventing antimicrobial resistance, improving outcomes for patients, and decreasing healthcare costs. Selecting the appropriate antibiotic, targeting the use of antibiotics to prevent overuse, adjusting dosage based on patient characteristics, selecting the most effective way of administering the drug, reducing unnecessarily long of therapy, and stopping the treatment of uninfected patients. Faculty such as Drs. Aeschlimann, Girotto and Nailor, all lead multidisciplinary antimicrobial stewardship programs at their respective practice sites.
Research stemming from three practice sites focuses on measuring stewardship efforts as an example for others to replicate or is otherwise designed to enhance stewardship efforts.
- Bennett N, Girotto JE.Antimicrobial Stewardship Initiatives: Pitfalls and Successes. Fourth Annual International Pediatric Antimicrobial Stewardship Conference, Kansas City. June 2013.
- Courter, J., Girotto, J. E.. Optimal Levofloxacin Dosing for Pediatric Community-Acquired Pneumonia. Mad-ID (Making A Difference in Infectious Disease Pharmacotherapy) Conference. Orlando FL, May 2013.
- Courter JD, Baker WL, Nowak KS, Smogowicz LA, Desjardins LL, Coleman CI, Girotto JE. (2010). Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. Annals of Pharmacotherapy. 44(3):471-478. Epub 2010 Feb 11.
- Courter JD, Kuti JL, Girotto JE, Nicolau DP. (2009). Optimizing bactericidal exposure for beta-lactams using extended infusions in the pediatric population. Pediatric Blood and Cancer.
- Fallon, R., Kuti, J., Doern, G., Girotto, J., & Nicolau, D. (2008). Pharmacodynamic Target Attainment of Oral β-Lactams for the Empiric Treatment of Acute Otitis Media in Children. Pediatric Drugs, 10(5), 329-335.
- Zmarlicka MT, Cardwell SM, Crandon JL, Nicolau DP, McClure MH, and Nailor MD. Evaluation of a disease state management guideline for urinary tract infection. International Journal of Antimicrobial Agents, 47: 451-456, 2016.
- Aitken SL, Dilworth TJ, Heil EL, and Nailor MD. Agricultural Applications for Antimicrobials: A Danger to Human Health, An Official Position Statement of the Society of Infectious Diseases Pharmacists. Pharmacotherapy, 36: 422-32, 2016.
- Ghazi IM, Nicolau DP, Nailor MD, Aslanzadeh J, Ross J, and Kuti JL. Antibiotic utilization and opportunities for stewardship among hospitalized patients with influenza respiratory tract infections. Infection Control and Hospital Epidemiology, 37: 583-9, 2016.
- Linder KE, Nicolau DP, and Nailor MD. Predicting and preventing antimicrobial resistance utilizing pharmacodynamics: Part 1 gram positive bacteria. Expert Opinion on Drug Metabolism and Toxicology, 12: 267-80, 2016.
In addition to their efforts at the respective practice sites, the faculty members concentrating on infectious diseases are also making a difference in the community.
Dr. Girotto has been an advocate within Connecticut to expand immunization services provided by pharmacists, has written many review articles on immunizations and has also developed continuing education offerings to educate pharmacists in the area of vaccinations.
- Tynik K, Girotto JE. (2013). Important Changes for Influenza Vaccination in 2013-2014. Pharmacy Journal of New England 10(4):22-25.
- Ventricelli D, Pisacane R, Girotto JE. (2013). Reliable Internet Vaccination Resources for Pharmacists. Pharmacy Journal of New England 10(2): 22-23.
- Girotto JE. (2013). Updated Immunization Schedules and Recommended Changes for Children and Adults. Pharmacy Journal of New England 10(2): 20-22.
- Girotto JE. (2013). Highlights of Influenza Recommendations: 2012-2013. Pharmacy Journal of New England 9(4):18 – 19.
- Girotto JE. (2012). Keeping up: Immunization Recommendation Changes in 2011-2012. Pharmacy Journal of New England 9(2):6 – 10.
- Cutting PE. Girotto JE. (2011). Immunization “CatchUp.” Pharmacy Journal of New England.
Dr. Nailor has formed a Connecticut Infectious Diseases Stewardship Group that meets several times a year to enhance the sharing of efforts within the state. Pharmacists interested in joining should e-mail Dr. Nailor. He also is a member of the Society of Infectious Diseases Pharmacist Government Affairs Committee that seeks to enhance infectious disease pharmacists efforts and promote safe and appropriate use of antimicrobials in both humans and the environment.
Post Graduate Training
Dr. Girotto is the director of a PGY II Pediatric Infectious Diseases Residency at Connecticut Children’s Medical Center. Inquiries regarding the program can be directly to her through her e-mail.
Dr. Nailor is the director of a PGY II Infectious Diseases and Antimicrobial Stewardship Residency at Hartford Hospital.