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Center for Antimicrobial Stewardship and Epidemiology (CASE):  Improving Patient Care Through Clinical Service, Teaching, and Research

Hannah R. Palmer, Pharm.D., BCPS, Jaye Weston, R.Ph., M.S., Layne Gentry, M.D., Miguel Salazar, Pharm.D., Ph.D., Kimberly Putney, Pharm.D., Craig Frost, M.B.A, R.Ph., Joyce A. Tipton, M.B.A., R.Ph., FASHP, Jessica Cottreau, Pharm.D., BCPS, Vincent H. Tam, Pharm.D., Kevin W. Garey, Pharm.D., M.S.

 

St. Luke’s Episcopal Hospital, Houston, Texas
University of Houston, College of Pharmacy, Houston Texas

Antimicrobial resistance and the cost of antibiotics are skyrocketing. To limit the emergence of resistance, assure the optimal use of antimicrobials, and contain antimicrobial costs, many hospitals have created antimicrobial stewardship programs. The goal of these programs is to optimize the use of antimicrobials, eliminate the overuse of inappropriate antimicrobials, and limit antibiotic selection pressure. In 2008, our institution formed the Center for Antimicrobial Stewardship and Epidemiology or CASE. The purpose of CASE was to take action that would improve the quality of care for patients as it related to antimicrobial therapy.  The charter of CASE contained specific aims for improving patient care, furthering clinical research, and training the next generation of clinical infectious diseases (ID) pharmacists. CASE administrative structure consists of a CASE medical director who reports to the hospital CEO. In addition, the hospital devoted resources for two ID pharmacists and a pharmacy fellow.  The CASE team is supported by a CASE advisory board, a CASE research collaborative including university faculty, and a dedicated training program for pharmacy fellows, residents, and students. This infrastructure was based on the newly published Infectious Diseases Society of America (IDSA) Antibiotic Stewardship Guidelines.

CASE uses a model in which a clinical scenario or problem is identified, a research project is undertaken to further elucidate the problem, and policy changes are made to improve patient outcomes. CASE found that patients infected with Pseudomonas aeruginosa organisms with a minimum inhibitory concentration (MIC) of 32 or 64mg/L had a 4-fold increased mortality compared to patients given other antibiotics. As a result, MICs are now made available to clinicians and antibiotics changed appropriately.  CASE also found that each day delay in starting therapy for positive Candida cultures caused a 50% increase in hospital mortality (p<0.001). The CASE team now screens all positive Candida cultures and initiates antifungal therapy in all patients with candidemia. Additionally, CASE has trained 4 ID pharmacy fellows and 2 PGY2 infectious diseases residents.  CASE is a required rotation for PGY1 residents (5 residents per year) and a minimum of two fourth year pharmacy students are always on a CASE rotation.  The growth of the program has been possible due to an extremely synergistic relationship with a college of pharmacy and infectious diseases faculty within the college. 

CASE is devoted to improving patient care, training the next generation of infectious diseases pharmacists, and changing local and national policy through high-level cutting edge research. CASES serves as a model for other tertiary care medical centers and provides an example of the significant collaborations that are possible between ID clinical pharmacists and pharmacy researchers.

]n@6` ^AH~Ҷu?p˝010_posters/Garey.pdf">pdf of the poster from the Midyear Meeting (511 KB).