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

– Wall Street Journal 9/3/08

During the last several decades, there has been a worldwide increase in the prevalence of drug-resistant pathogens.  In 2011, the Infectious Diseases Society of America estimated the annual cost to the U.S. healthcare system from antibiotic-resistant infections is as high as $34 billion, including an additional eight million hospital days.   These infections have also been associated with worse patient outcomes and high rates of mortality, often due to lack of remaining antimicrobial options.  A concerning lack of new antimicrobial agents in the drug development pipeline necessitates judicious antimicrobial management 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:

  • Hou et al (2014) – Implementation of an antimicrobial stewardship service in an ICU led to a reduction in patient antibiotic days by approximately 50% and markedly reduced resistance to several antibiotic classes.
  • Bosso et al (2011) – A review antimicrobial stewardship programs for the management of community-acquired pneumonia resulted in increased levels of appropriate antibiotic prescribing, reduced bacterial resistance, decreased hospital costs, and improved patient outcomes (length of stay and rates of clinical failure).
  • Fishman et al (2006) – Antimicrobial stewardship implementation led to increased rates of appropriate antibiotic selection, decreased clinical failures, and decreased rates of resistance.  Decreases in C. difficile and VRE infections were also observed.
  • Carling et al (2003) – Multidisciplinary prospective interventions resulted in a 22% decrease in the use of broad-spectrum antibiotics, decreased C. difficile infections, and decreased rates of drug-resistant Enterobacteriaceae.

With the patients in mind, antimicrobial stewardship is everyone’s responsibility!

Meet Our Team

E. Yoko Furuya, MDE. 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)

Clinical Pharmacy Manager, Infectious Diseases

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.

Monica Mehta, PharmD, MPH, BCPS

Clinical Pharmacy Manager, Infectious Diseases

Monica Mehta received her B.S. in pharmacy from The University of Houston, PharmD from The University of Texas at Austin, and M.P.H. from Columbia University, Mailman School of Public Health.  Dr. Mehta completed a PGY-2 Infectious Diseases Pharmacy Residency at NewYork-Presbyterian Hospital in 2008 and is also a board certified pharmacotherapy specialist. She has been a member of the ASP team since 2012.   Academic and research interests include health care reform, social and population determinants of health, pharmacoeconomics, HIV management, influenza prevention and management, PK/PD dosing of antimicrobials, implications of beta-lactam allergies, as well as management of MRSA infections.

Brian C. Nelson, PharmD

Clinical Pharmacy Manager, Infectious Diseases

After receiving his PharmD from Mercer University College of Pharmacy at Atlanta in 2012, Dr. Nelson completed a PGY-1 Acute Care Residency with University of California, San Diego Health System and subsequently came to NewYork-Presbyterian Hospital for a PGY-2 Infectious Diseases Pharmacy Residency.  He is the newest member of the ASP, joining in 2014.  His clinical and research interests include treatment of resistant gram-negative organisms, PK/PD dosing of antimicrobials, HIV management, and utilization of IT systems to promote improved infection management.

Resources and Guidelines

NewYork-Presbyterian Hospital/Columbia University Medical Center Clinical References

IDSA Antimicrobial Stewardship Guidelines

IDSA Practice Guidelines

IDSA – “Combatting Antimicrobial Resistance to Save Lives”

Hospital Pharmacy Journal - Key Aspects of a Successful Antibiotic Stewardship Program