Internet Enduring Material Jointly Provided by Stanford University School of Medicine (CME) and University of Rhode Island College of Pharmacy. Presented by The Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine

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 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 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.

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

• Release Date: November 2, 2015
  Latest Review Date: October 27, 2017
  Expiration Date: October 27, 2020
  Estimated Time to Complete: 2 Hours
  CME Credits Offered: 2.00
  CPE Credits: 2.0 contact hours (0.20 ceus)
  Registration Fee: FREE
  
  Pharmacists wishing to claim ACPE credit must use the procedure outlined below:
  Review the information below and complete the entire activity. Complete the Post-test and Evaluation Survey. You must receive a score of 75% or higher on the post-test in order to pass. 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.
  
  All participants will have the opportunity to evaluate the educational session and speaker and to identify future educational needs.
  
  A program evaluation must be completed at www.uripharmacycpd.org within 60 days of completing the program in order to receive CE credit.  CE credit will be transferred to the CPE Monitor upon successful completion of the program evaluation. Transfer of CE credit should be verified at mycpemonitor.net where CE statements are available to print. Please refer to the evaluation instructions that follow for completing program evaluations and reporting CE credit.
  
  After you successfully complete the activity, you should email cmeonline@stanford.edu for an activity link to the URI Continuing Professional Development (CPD) Management System at: www.uripharmacycpd.org to complete a program evaluation, claim your ACPE credit, and report your CE participation in the activity

Disclosures

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

The University of Rhode Island College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.  This is an application-based educational activity. Pharmacists will receive 2.0 contact hours (0.20 ceus) for the educational activity. No partial credit is available. Universal Activity Number (UAN):  0060-9999-18-024-H01-P

Accessibility Statement
 
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require special accommodations, including dietary concerns, please contact the CME Conference Coordinator.

Cultural and Linguistic Competency

The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal 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 Multicultural Health Portal: http://lane.stanford.edu/portals/cultural.html

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 list, please view the References/Bibliography page in the Course.

No faculty are available for this activity at this time.

This activity received no commercial support.