SUMMARY

Inappropriate antimicrobial use in hospitalized patients contributes to growing antimicrobial resistance and antimicrobial-related complications and infections like Clostridium difficile infection (CDI). Antimicrobial stewardship focuses on using the appropriate medication, dose, route, and duration based on patient-specific factors to avoid unnecessary use and/or overuse of antimicrobials, which contributes to healthcare costs, adverse drug events, and antimicrobial resistance. Applying antimicrobial stewardship practices in hospitalized patients has traditionally been within the domain of infection control and infectious disease experts. Frontline providers like hospitalists, however, can serve as critical partners in these efforts and can reduce the development of hospital-acquired infections (HAIs), which are increasingly caused by resistant strains. These HAIs contribute to worse patient outcomes, longer lengths of stay, and higher healthcare expenditures. In this educational module, we will explore how hospitalists can apply antimicrobial stewardship practices to improve prescribing practices for hospitalized patients, as well as recognize and reduce risk factors for hospital-acquired infections.

GOAL

To recognize and apply antimicrobial stewardship principles to hospitalized patients with bacterial infections as well as methods to reduce HAIs and antimicrobial resistance.

TARGET AUDIENCE

This activity is designed for hospitalists and residents interested in the field of consultative medicine. 

LEARNING OBJECTIVES

After completing the module, the participant should be able to:

• Determine initial appropriate antimicrobial treatment for the hospitalized patient with suspected bacterial infection based on patient-specific factors and hospital epidemiologic data.
• Use the 5 principles of antimicrobial stewardship to tailor antimicrobial treatment.
• Recognize risk factors and ways to reduce hospital-acquired infections, focusing on catheter-associated urinary tract infections.
• Identify methods to reduce transmission and risk for carbapenem-resistant Enterobacteriaceae infection.

CME INFORMATION

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Virginia School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit.^TM Physicians should claim only the credit commensurate with the extent of their participation in the activity

Release date: June 30, 2016                     Expiration date: June 30, 2019.

Estimated time to complete activity: 1 hour

FACULTY & FACULTY DISCLOSURES

Full Disclosure Policy Affecting CME Activities:

The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.

The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.

All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.

The faculty and staff of the University of Virginia Office of Continuing Medical Education and ASiM have no financial affiliations to disclose.

The following relationships have been reported for faculty of this activity:

Leonard Feldman, MD, FACP, SFHM (Chair)
Associate Professor of Medicine and Pediatrics
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative & Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Megan R. Mack, MD
Department of Internal Medicine
Clinical Assistant Professor
University of Michigan Hospital and Health System
Ann Arbor, Michigan
Dr Mack reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Chris Arnold, MD (Peer Reviewer)
Assistant Professor
Division of Infectious Diseases and International Health
University of Virginia Health System
Charlottesville, Virginia
Dr Arnold reports receiving grants/research support for RSV treatment as part of a multicenter trial from Alios BioPharma Inc.

Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices

The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.

All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

SHM CONFLICT OF INTEREST DISCLOSURE POLICY

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

DISCLAIMER

The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only. The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.

Click here to download the references for this educational activity.

INSTRUCTIONS

The following is an interactive case-based module designed to help you gauge your basic knowledge of bacterial infections and then direct you to specific areas you may need to focus on. It consists of 3 sections: a non-designated pre-test, the interactive activity, and a CME post-test and evaluation. All 3 sections must be completed to receive CME credit. Participants must receive a post-test score of 70% or higher to pass and will have 3 chances to do so. A certificate of participation will be available online immediately following successful completion of the activity.

Supported by an educational grant from Merck & Co, Inc.