Host

Priya Nori, MD
Chair of IDSA Academy's Antimicrobial Stewardship Curriculum Workgroup
Associate Professor, Department of Medicine (Infectious Diseases)
Associate Professor, Department of Orthopaedic Surgery
Medical Director, Antibiotic Stewardship Program
Montefiore Medical Center, Bronx, NY

Moderator

David C Gaston, MD PhD
Assistant Professor, Department of Pathology, Microbiology, and Immunology
Medical Director, Molecular Infectious Diseases Laboratory (MIDL)
Vanderbilt University Medical Center, Nashville TN

Panelists

Ahmed Babiker (he/him), MBBS 
Assistant Professor 
Division of Infectious Diseases, Department of Medicine  
Department of Pathology and Laboratory Medicine 
Emory University School of Medicine 

Romney Humphries, PhD D(ABMM), FAAM, FIDSA
Professor, PMI
Medical Director, Infectious Diseases Laboratories
Division Director, Laboratory Medicine
Vanderbilt University Medical Center, Nashville TN

Questions:

Question #1: How do stewardship and microbiology work together to impact patient care?

Question #2: What are some examples of evidence- based initiatives that involve a partnership between microbiology and stewardship that can improve antibiotic use and antimicrobial resistance testing on a larger scale?

Question #3: Describe some examples of novel interventions or innovations implemented at your program which have helped improve antibiotic use.

Question #4: What are some national challenges faced by microbiology labs, and how can stewardship programs advocate for the needs of microbiology labs?

Question #5: In what additional ways would you like to see clinical microbiology and antimicrobial stewardship teams working together in the future?

References:

Nudging

Example of how an EMR nudge decreased HO-C. diff testing at Emory
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909614/

Rapid Diagnostics with Stewardship Teams

Meta-analysis of rapid diagnostics with/without stewardship teams:
https://pubmed.ncbi.nlm.nih.gov/27678085/

ID consultations improve outcomes

Crypto
https://academic.oup.com/cid/article/64/5/558/2623957

MDROs
https://academic.oup.com/ofid/article/5/3/ofy026/4925511

Enterococcus BSI
https://academic.oup.com/ofid/article/7/3/ofaa064/5740231

Candidemia  (systemic review/meta-analysis)
https://academic.oup.com/ofid/article/7/9/ofaa270/5866621

Staph Aureus
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2760667

Micro Rounds

The use of teaching vignettes in micro rounds at Emory (mostly the educational aspect of micro rounds)
https://academic.oup.com/ajcp/article/141/3/318/1766126

Paper about micro rounds, specifically about Pharmacists coming to micro rounds and opportunities for stewardship interventions at rounds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152709/

Andrea also covers micro rounds in this AMS article
https://asm.org/Articles/2020/November/Rounding-in-the-Clinical-Microbiology-Lab

Diagnostic stewardship
https://jamanetwork.com/journals/jama/article-abstract/2647071

Role of lab in AMS

Old review paper which touches on multiple topics discussed
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217798/#:~:text=It%20is%20mentioned%20tha
t%20%E2%80%9Cthe,organisms%20and%20in%20the%20molecular

Example of Tumor board for metagenomics in this landmark paper by USCF where they applied metagenomics for CNS infection diagnosis:
https://pubmed.ncbi.nlm.nih.gov/31189036/

VALID ACT
https://asm.org/Articles/Policy/2022/May-2022/VALID-Act

Updating Breakpoints
https://pubmed.ncbi.nlm.nih.gov/30971460/

MALDI + Stewardship has better value than MALDI alone
Pliakos EE, et al. The Cost-Effectiveness of Rapid Diagnostic Testing for the Diagnosis of Bloodstream Infections with or without Antimicrobial Stewardship. Clin Microbiol Rev. 2018 May 30;31(3):e00095-17. doi: 10.1128/CMR.00095-17. PMID: 29848775; PMCID: PMC6056844.

Considerations of best-use for NGS technologies in ID diagnostics
Azar MM, et al; Transplant ID Diagnostics Consensus Conference Working Group. A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients. Am J Transplant. 2022 Jul 13. doi: 10.1111/ajt.17147. Epub ahead of print. PMID: 35822346.

Parrish NF and Gaston DC; Metagenomics in Infectious Disease Diagnostics: Toward Best-Use Practices to Optimize Actionable Results. Transplant Infectious Diseases. Accepted, in press.

Using NGS approaches with BAL samples
Gaston DC, et al; Evaluation of Metagenomic and Targeted Next-Generation Sequencing Workflows for Detection of Respiratory Pathogens from Bronchoalveolar Lavage Fluid Specimens. J Clin Microbiol. 2022 Jul 20;60(7):e0052622. doi: 10.1128/jcm.00526-22. Epub 2022 Jun 13. PMID: 35695488; PMCID: PMC9297812.