Optimizing Antimicrobial Therapy with Timeouts

Dr. Arjun Srinivasan (CAPT, USPHS)

Now Open!

Optimizing Antimicrobial Therapy with Timeouts

Internet Enduring Material Jointly Provided by:

Stanford University School of Medicine (CME) and Tufts University School of Medicine (CPE)

Presented by:

The Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine

Course Description

Antibiotic misuse is widespread and has dire patient and public health consequences. National organizations, including the CDC and the Joint Commission, advocate for a formal “Antibiotic Timeout” to reassess empiric antibiotics 48-72 hours after their initiation. During this Timeout, clinicians should answer the following questions:

• Does the patient have an infection that will respond to antibiotics?
• If so, is the patient on the right antibiotic(s) and is it being administered in the correct dose and by the correct route and (in the case of intravenous therapy) duration of infusion?
• Can a more targeted antibiotic regimen be used to treat the infection (i.e., de-escalation)?
• For how long should the antibiotic(s) be administered?

This CME/CPE activity provides a practical approach to performing “Antibiotic Timeouts” in the inpatient setting. Using short, didactic sessions, we will provide examples on how to reassess antibiotic therapy started empirically using clinical, laboratory, and microbiological data. The majority of this CME/CPE will be high-yield, interactive inpatient cases covering skin and soft tissue infections, pneumonia, catheter-associated urinary tract infections, and neutropenic fever, that illustrate the timeout process and the principles of appropriate use of antimicrobials.

Intended Audience

This course is designed to meet the educational needs of physicians from a wide variety of specialties including cardiology, critical care, family practice, general surgery, hospitalists, infectious diseases, internal medicine, neurology, oncology, pediatrics, and urology, as well as pharmacists, nurse practitioners, and physician assistants.

Dates, Duration & Fee

• Release Date: November 2, 2015
• Expiration Date: November 2, 2017
• Estimated Time to Complete: 2 Hours
• CME/CPE Credits Offered: 2.00
• Registration Fee: FREE
• There is a $15 fee for pharmacists to obtain ACPE credit.

To Obtain CME Credits or Certificate of Participation

• Review the information below and complete the entire activity.
• Complete the Post-test, Evaluation Survey, and Activity Completion Statement at the end of the activity.
• You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
• Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
• Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

To Obtain CPE Credits

• Register and view all the course content.
• Receive a score of 75% or higher on the post-test, you will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
• Complete the Evaluation Survey, which includes providing your name, email address, and NABP e-Profile ID to Stanford
• Attest to the Activity Completion Statement at the end of the activity

After successfully attesting your completion of the activity, a link to pay for CPE credit at the TUSM OCE online store will be avilable on the Activity Completion Statement page.

All pharmacists licensed in the United States and wishing to obtain ACPE credit are required to submit to TUSM OCE; a NABP e-Profile ID and the month/day of birth in a four-digit format, e.g., January 5 = 0105. Contact hours will be issued through a NABP-managed online tracking system called CPE Monitor.

The above data and $15 fee will be required at the TUSM OCE online store for processing.

Learning Objectives

At the conclusion of this activity, participants should be able to:

• Describe the principles and shortcomings of empiric antibiotic therapy.
• Routinely conduct all steps of the antibiotic timeout, in accordance with CDC guidelines on antibiotic stewardship that include:
• Analyzing laboratory and clinical data
• Formulating a rationale for continued antibiotic use
• Documenting rationale in patient’s electronic medical record
• Determining the most effective duration of antibiotic therapy
• Deciding when it is appropriate to switch from an IV to oral route of antibiotic administration

Table of Contents

1. Introduction
2. Empiric Antibiotic Therapy
3. Antibiotic Timeout Cases
4. Course Wrap-up
5. Resources and References
6. Help!

Disclosures of Relevant Financial Relationships with Commercial Interests

All faculty, course directors, planning committee members and others in a position to control the content of an educational activity are required to disclose to the audience any relevant financial relationships with commercial interests. Conflicts of interest resulting from a relevant financial relationship are resolved prior to activity release.

The following planner indicated having relevant relationships with industry to disclose:

Stan Deresinski, MD, FIDSA
Clinical Professor of Infectious Disease
Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Course Director
Bayer & Cubist Pharmaceuticals - Advisory Board Member

The following planners, speakers, authors, and reviewers have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Stan Deresinski, MD, FIDSA
Clinical Professor of Infectious Disease
Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Speaker/Author

Marisa Holubar, MD, MS
Clinical Assistant Professor in Medicine, Division of Infectious Disease and Geographic Medicine
Associate Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Course Director
Speaker/Author

Elizabeth Robilotti, MD, MPH
Assistant Attending, Infectious Diseases
Associate Director, Infection Control
Memorial Hospital for Cancer and Allied Diseases,
Memorial Sloan Kettering Cancer Center, New York, NY
Course Director
Reviewer

Emily Mui, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Stanford Hospital and Clinics
Planner

Lina Meng, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Stanford Hospital and Clinics
Planner

Arjun Srinivasan, MD (CAPT, USPHS)
Associate Director for Healthcare-Associated Infection Prevention Programs
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Speaker

Kirthana R. Beaulac, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Tufts Medical Center, Boston, MA
Reviewer

Technical Design and Development

Mike McAuliffe
Stanford EdTech

Kimberly Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

Hardware/Software Requirements

Minimum Hardware Requirements: WINDOWS: Processor: Intel Core 2 Duo, RAM: 2 GB, Operating System: Vista, Windows 7, 8, or better. MAC: Processor: Intel Core 2 Duo, RAM: 2 GB, Operating System: 10.7 or better.

Minimum Software Requirements: Web Browser: Chrome (v40.0 or higher) or Safari (v5.0.6 or higher) with Javascript enabled. If you don't have it, you will need a current version of Adobe Flash Player, which can be downloaded here: http://get.adobe.com/flashplayer/

Minimum Internet: LAN, Cable, or DSL connection is highly recommended, Cellular (4G/LTE) may also be used.

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacists

Tufts University School of Medicine Office of Continuing Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This activity is available for 2.00 contact hours, Universal Activity Number: 0054-9999-15-007-H01-P

Type of continuing pharmacy education: application-based

Commercial Support Acknowledgement

This activity received no commercial support.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME/CPE activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws. You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html.

TUSM OCE Policy on Privacy and Confidentiality

Click here to review the TUSM OCE Policy on Privacy and Confidentiality

SCCME Privacy Policy

Click here to review the Stanford Center for CME Privacy Policy.

Contact Information

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team.

If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu.

For question regarding ACPE certification, please contact Tufts University School of Medicine - Office of Continuing Education at med-oce@tufts.edu or 617-636-6579.

Bibliography

Deresinski S. Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. 2007;45 Suppl 3:S177-83. PMID: 17712744

Oxman DA, Adams CD, Deluke G, et al. Improving antibiotic de-escalation in suspected ventilator-associated pneumonia: an observational study with a pharmacist-driven intervention. J Pharm Pract. 2015;28(5):457-61. PMID: 24651641

Duchene E, Montassier E, Boutoille D, et al. Why is antimicrobial de-escalation under-prescribed for urinary tract infections? Infection. 2013;41(1):211-4. PMID: 23124907

American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. PMID: 15699079

Freifeld AG, Bow EJ, Sepkowitz KA, et al, Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93. PMID: 21258094

Hooton TM, Bradley SF, Cardenas DD, et al.; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-63. PMID: 20175247

Mandell LA, Wunderink RG, Anzueto A, et al.; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 (Suppl 2):S27-72. PMID: 17278083

Stevens DL, Bisno AL, Chambers HF, et al, Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014; 59(2):e10-52. doi: 10.1093/cid/ciu444. Erratum in: Clin Infect Dis. 2015; 60(9):1448. Dosage error in article text. PMID: 24973422

For a complete listing see the Resources and References module in the course.

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