Antimicrobial Stewardship in Non-Traditional Settings: A Practical Guide

The evolution of Antimicrobial Resistance is outpacing the ability to create novel antibiotics, which is proving to be a global problem in the fact of climate change, population growth, demographic shifts toward aging populations, emerging infections, and other crises. Therefore, clinicians are forced to use the existing antimicrobials more responsibly to preserve their longevity for generations to come. In a parallel vein, there has been a recent regulatory acknowledgement of the importance of prudent antimicrobial prescribing, mandating the implementation of Antimicrobial Stewardship across all healthcare settings. This is harder to manage in a non-traditional setting, which include long-term care facilities, outpatient care clinics, urgent care centers, and others. Given the trends in patient care in these settings--particularly where the aging community is concerned--this is proving to be a growing problem. This is troublesome even for spaces that have university and large hospital affiliations.

There is a plethora of data describing the implementation and outcomes of Antimicrobial Stewardship Programs in acute-care hospitals with open-access, evidence-based guidelines endorsed by the Infectious Diseases Society of America. However, non-traditional settings often find themselves struggling to implement the same practices and procedures due to their unique needs and limited resources. There may be variability in access to resources, applicability, and patient-type. This book seeks to inform those in non-traditional healthcare settings on the principles, practice, and outcomes of Antimicrobial Stewardship Programs to improve patient care across all settings.

The text begins by unpacking Antimicrobial Stewardship in nontraditional settings then covers specific environments, including long-term care facilities, outpatient clinics, and emergency departments. The text also covers special topics, including veterinary medicine, HIV, oncology, and immunocompromised patients, pediatrics, neonates, transplant, and critical care patients.

Shira Doron, MD
Antimicrobial Steward
Associate Hospital Epidemiologist
Associate Professor of Medicine
Tufts Medical Center

Maureen Campion, PharmD, BCIDP
Senior Clinical Pharmacy Specialist, Infectious Diseases
Department of Pharmacy
Tufts Medical Center

Dr. Shira Doron is an infectious disease specialist in Boston. Dr. Doron cares for patients with infections that are difficult to diagnose and treat, and can be life-threatening. She received her medical degree from George Washington University School of Medicine in 1998 and has been in practice for over 20 years. She is currently an associate professor of medicine at Tufts Medical Center. Her interests include hospital epidemiology, antimicrobial stewardship, emerging infections, and infection control and prevention.