The mission of the antimicrobial stewardship program is to optimize clinical outcomes of antimicrobial use in adults across the UCLA Health System. The ASP works to ensure the optimal selection, dose, and duration of antimicrobials that lead to the best clinical outcome for the treatment or prevention of infection while producing the fewest possible side effects and the lowest risk for subsequent resistance.
After the CDC's Vital Signs report, carbapenem-resistant Enterobacteriaceae (CRE) has been receiving attention from various news organizations and has been nicknamed the "nightmare bacteria" (here, here, and here). Our program works with microbiology, infection prevention, pharmacy, quality management, infecious diseases, and many other departments and are committed to UCLA's vision of healing humankind, one patient at a time, by improving health, alleviating suffering and delivering acts of kindness.
Flu Watch 2013
LA County Flu watch
Click here to view the UCLA Antimicrobial Guidebook section on Seasonal Influenza Diagnosis and Management in ADULTS
Click here to view the UCLA Antimicrobial Guidebook section on Seasonal Influenza Diagnosis and Management in PEDIATRICS
Click here to read the latest information on flu surveillance and related disease updates for Los Angeles County.
The New England Journal of Medicine publishes a perspective on The Future of Antibiotics and Resistance
Today the NEJM published a perspective article, "The Furture of Antibiotics and Resistance", which briefly touches upon the many challenges of antimicrobial stewardship. Drs. Brad Spellberg, John G. Bartlett and David N. Gilbert propose several avenues to combat antimicrobial resistance, including advancing infection prevention, policy changes to support new classes of antimicrobials, preserving existing antimicrobials through national reporting and benchmarking, exploring microbe-attacking treatments (such as infusion of monoclonal antibodies and white cells that kill microbes), and treatments that attack host targets rather than microbial targets (such as sequestration of host nutrient to prevent microbial access to nutrients).
We enourage you to read the article, which can be found here.
CDC Resleases Joint Statement on Antibiotic Resistance from 25 National Health Organizations
As part of Get Smart About Antibiotics week, the CDC, CDDEP & RWJF hosted a telebriefing titled "Uniting To Preserve Antibiotics Effectiveness and Combat Resistance".
On the call, Arjun Srinivasan, Centers for Disease Control and Prevention associate director for healthcare-associated infection prevention programs and Ramanan Laxminararayan, director of the Center for Disease Dynamics, Economics & Policy (CDDEP), unveiled the details of an unprecedented joint partnership with 25 National Health Organizations to fight against antibiotic resistance. The full statement can be found here.
In addition, CDDEP's Extending the Cure project releaseed new research identifying patterns of antibiotic overuse in certain areas of the United States, a bar graph and a map. Both are interactive and can be found here: www.cddep.org/map
Risk of Cardiovascular Death in Patients taking Azithromycin
A new study in the New England Journal of Medicine by Wayne A. Ray et. al. has found patients taking azithromycin, as compared to those who took no antibiotics, ciprofloxacillin, amoxicillin or levofloxacillin, had an increased risk of cardiovascular death during five days of therapy. The authors conducted a retrospective cohort study of mortality among patients who used azithromycin. The cohort included patients enrolled in the Tennessee Medicaid program who had been prescribed azithromycin between 1992 and 2006 and met eligibility criteria on the date the prescription was filled. Criteria included: excluding persons at high risk for death from unrelated causes, persons 30-74 years of age, not life-threatening noncardsiovascular illness, not received a diagnosis of drug abuse or resided in a nursing home in the previous year, not been hospitalized in the previous 30 days, at least 365 days of Medicaid enrollment and regular use of medical care. The study found a 5-day course of azithromycin was associated with a small absolute increase in the risk of cardiovascular death. The study analyzed two periods: a 5-day period and a 10-day period. When compared to a matched period of no antibiotic treatment, a 5-day course of azithromycin was associated with an increased risk of both cardiovascular death (hazard ratio = 2.88 (95% CI, 1.79 to 4.63; P<0.001)) and death from any cause (hazard ratio = 1.85; 95% CI, 1.25 to 2.75; P=0.002) during that interval. Compared to amoxicillin therapy, a 5-day course of azithromycin was associated with significant increases in the risk of both cardiovascular death and death from any cause. The same results were found with ciprofloxacin compared to azithromycin (though death from any cause was a nonsignificant increase). The risk did not differ significantly from the risk with levofloxacin.
This study has important implications on the use of azithromycin, particularly for patients with increased cardiovascular risk and we encourage you to read the article.
Bug Bits: Let's talk dirty
Updated: March 7, 2012
The CDC has issued a report that highlights six steps to prevent spread of deadly C. difficile bacteria, which impacts patients in nursing homes and outpatient care, not just hospitals. C. difficile is linked to about 14,000 U.S. deaths every year. Those most at risk are people who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths occur in people 65 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the healthcare system. However, the Vital Signs report shows that these hospital estimates may only represent one part of C. difficile's overall impact.
2. Test for C. difficile when patients have diarrhea while on antibiotics or within several months of taking them.
3. Isolate patients with C. difficile immediately.
4. Wear gloves and gowns when treating patients with C. difficile, even during short visits. Hand sanitizer does not kill C. difficile, and hand washing may not be sufficient.
5. Clean room surfaces with bleach or another EPA-approved, spore-killing disinfectant after a patient with C. difficile has been treated there.
6. When a patient transfers, notify the new facility if the patient has a C. difficile infection.
The full report can be found here.
1. Prescribe and use antibiotics carefully. About 50% of all antibiotics given are not needed, unnecessarily raising the risk of C. difficile infections.