“Hospitals are turning to a new breed of antibiotic SWAT team to win the war against "superbugs""

– Wall Street Journal 9/3/08

Antimicrobial resistance is a significant and progressively worsening problem at healthcare facilities around the world. This fact, combined with the lack of new antimicrobial agents in the drug development pipeline, indicates that judicious antimicrobial management is necessary to preserve the antimicrobials currently available.

Antimicrobial stewardship activities have been ongoing since 2000 at NewYork-Presbyterian Hospital (NYP), but a hospital-wide Antimicrobial Stewardship Program (ASP) was formalized in 2007 through a joint effort of the Division of Infectious Diseases, the Department of Pharmacy, the Department of Infection Control and Prevention, and the Department of Microbiology. The program aims to optimize antimicrobial use with the intention of stabilizing antimicrobial resistance, improving patient safety, and decreasing antimicrobial costs.   

Adverse outcomes related to antimicrobial use result from inappropriate choice, dose, formulation, or duration of antimicrobials and include increased cost and antimicrobial resistance, along with increased morbidity, mortality, and length of stay. Stabilizing antimicrobial resistance requires a multifaceted approach including formulary restrictions, education and guidelines, review and feedback, and close surveillance of antimicrobial utilization and resistance patterns, with interventions made on a daily basis to optimize antimicrobial therapy.  Recent literature demonstrates that these activities are most successful with the implementation of multidisciplinary antimicrobial management teams involving infectious diseases physicians and infectious diseases-trained clinical pharmacists:

• Carling et al (1999) – Comparison of 14 hospitals showed that only a prospective multidisciplinary intervention program was correlated with a decrease in antimicrobial cost.
• Bantar et al (2003) – Multidisciplinary antimicrobial treatment committee led to decreased antimicrobial costs (savings >$900,000) and decrease in certain types of antimicrobial resistance.
• Gums et al (1999) – Multidisciplinary team led to a decrease in length of stay (by 3.3 days) and in median hospital costs ($2642 per intervention)

Meet Our Team

E. Yoko Furuya, MD MS

Medical Director, Infection Prevention & Control

Director, Antimicrobial Stewardship Program

Dr. Furuya received her M.D. degree from the University of Pennsylvania School of Medicine. Subsequently, she did her residency training in internal medicine at the Hospital of the University of Pennsylvania and then completed a clinical fellowship in the ID Division at Columbia University with support from the National Institute of Health Ruth L. Kirschstein National Research Service Award. During her fellowship she completed an M.S. degree in Epidemiology at the Mailman School of Public Health, Columbia University. She is now Assistant Professor of Clinical Medicine in the Division of Infectious Diseases at Columbia University, and her research interests are focused in the areas of hospital epidemiology and antimicrobial resistance. She is a co-investigator on several NIH- and CDC-funded studies looking at multidrug-resistant gram-negative organisms, infection control practices, and costs of antimicrobial resistance. 

Christine J. Kubin, PharmD, BCPS (AQ-ID)

Dr. Kubin received her PharmD from the University of North Carolina at Chapel Hill.  After completing a PGY-1 Pharmacy Practice Residency at the Bronx VA Medical Center, she joined the clinical pharmacy staff at NewYork-Presbyterian Hospital in 1999.  Dr. Kubin is also a board certified pharmacotherapy specialist with added qualifications in infectious diseases.  She has been a member of the ASP team since 2000.  Her clinical and research interests are focused on the epidemiology and treatment of multidrug-resistant gram-negative organisms, PK/PD dosing, antimicrobial use and impact on resistance, and infections in immunocompromised hosts.

Kelly Wright, PharmD, BCPS

After receiving her PharmD from Massachusetts College of Pharmacy and Health Sciences in 2005, Dr. Wright completed a PGY-1 Pharmacy Practice Residency at the Veterans Affairs – Connecticut Health Care System and a PGY-2 Infectious Diseases Pharmacy Residency at Boston Medical Center.  Dr. Wright is also a board certified pharmacotherapy specialist.  She has been a member of the ASP team since 2007.  Her clinical and research interests include antiretroviral pharmacotherapy, PK/PD dosing of antimicrobials , and treatment of multidrug-resistant Gram-negative organisms.  

Asma Lat, PharmD

After receiving her PharmD from The University of Texas at Austin College of Pharmacy in 2007, Dr. Lat completed a PGY-1 Pharmacy Practice Residency at the University of Pittsburgh Medical Center and a PGY-2 Infectious Diseases Pharmacy Residency at the South Texas Veterans Affairs Health Care System/University of Texas Health Sciences Center at San Antonio.  She has been a member of the ASP team since 2009.  Her clinical and research interests include optimization of PK/PD dosing of antimicrobials, antifungal pharmacotherapy, and in vitro/in vivo correlation of treatment for multidrug-resistant Gram-negative organisms.  

Resources and Links           

                Click here for a link to Clinical References               

Useful Links

                IDSA Antimicrobial Stewardship Guidelines

http://www.idsociety.org/content.aspx?id=4428#Antimicrobial_Stewardship

                IDSA Practice Guidelines

                http://www.idsociety.org/Content.aspx?id=9088