title: Antimicrobial Stewardship Programs: Comparison of a Program with Infectious Diseases Pharmacist Support to a Program with a Geographic Pharmacist Staffing Model.
abstract: BACKGROUND
  Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known.
  
  
  OBJECTIVE
  To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital).
  
  
  METHODS
  We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship.
  
  
  RESULTS
  At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists (P < .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital (P < .03). When a patient's illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital (P < .0002).
  
  
  CONCLUSIONS
  An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists.
authors.affiliation: Chief, Infectious Diseases, VA-Eastern Colorado Healthcare System , Denver, Colorado ; Associate Professor, Department of Medicine, University of Colorado Denver.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Bessesen
authors.affiliation: Infectious Diseases Fellow, Cedars-Sinai/UCLA Multicampus Program in Infectious Diseases , Los Angeles, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ma
authors.affiliation: Clinical Pharmacy, Moran Eye Center, University of Utah , Salt Lake City, Utah.
authors.forename: Daniel
authors.initials: D
authors.lastname: Clegg
authors.affiliation: Internal Medicine Clinical Specialist, VA-Eastern Colorado Healthcare System , Denver, Colorado ; Clinical Associate Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus , Aurora, Colorado.
authors.forename: Randolph V
authors.initials: RV
authors.lastname: Fugit
authors.affiliation: Clinical Pharmacy Program Manager, VA-Eastern Colorado Healthcare System , Denver, Colorado.
authors.forename: Anthony
authors.initials: A
authors.lastname: Pepe
authors.affiliation: Chief, Infectious Diseases Section, VA Greater Los Angeles Healthcare System ; Professor of Clinical Medicine, David Geffen School of Medicine at UCLA , Los Angeles, California.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: Associate Clinical Professor of Medicine, David Geffen School of Medicine at UCLA ; Infectious Diseases Section, VA Greater Los Angeles Healthcare System , Los Angeles, California .
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Graber
keywords: anti-infective agents; antibacterial agents; antimicrobial stewardship; pharmacists