Improving inpatient care through antimicrobial stewardship: A case‐based approach to managing acute infections: Supplement to the Journal of Hospital Medicine

Estimated time to complete the activity: 3 hours 30 minutes

Jointly sponsored by the American Academy of CME and Global Education Exchange, Inc

This activity is supported by an educational grant from Merck & Co., Inc.

There is no fee to participate in this CME‐certified activity.

Program Overview

Early and appropriate treatment of acute infections, especially in critically ill and immunocompromised patients, is paramount to successful outcomes. Appropriate empiric therapy often requires the use of multiple broad‐spectrum agents that must be used judiciously to preserve antimicrobial activity over time. Critical components of antimicrobial stewardship include the selection of appropriate antibiotics, de‐escalation of therapy after 2 or 3 days of empiric treatment, and a strategy for the duration and discontinuation of therapy. An evidence‐based approach to these essential stewardship factors will improve patient outcomes by decreasing unnecessary antimicrobial exposures and associated unwanted effects as well as reduce the risk for emergence of antimicrobial resistance.

The intent of this educational activity is to illustrate these components of antimicrobial stewardship in a practical, case‐based format. Since hospitalists and intensivists play a central role in the formation and operation of a successful antimicrobial stewardship program, special consideration will be given to strategies that they can apply in their daily practices.

Target Audience

This activity was designed to meet the needs of hospitalists and intensivists who are involved in the diagnosis, management, and treatment of infectious diseases in the hospital setting. Other healthcare professionals are also invited to participate.

Faculty and Topics

Empiric Antibiotic Selection Strategies for Healthcare‐Associated Pneumonia, Intra‐abdominal Infections, and Catheter‐Associated Bacteremia

David R. Snydman, MD, FACP, FIDSA

Chief, Division of Geographic Medicine and Infectious Diseases

Tufts Medical Center

Professor of Medicine

Tufts University School of Medicine

Boston, Massachusetts

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of CME, Inc. and Global Education Exchange, Inc. American Academy of CME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

American Academy of CME designates this enduring material for a maximum of 3.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflict of Interest

According to the disclosure policy of the American Academy of CME, all faculty, planning committee members, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials were reviewed for fair balance, scientific objectivity, and levels of evidence.

Academy planner John JD Juchniewicz, MCIS, CCMEP, and GLOBEX planners and editors Meri D. Pozo, PhD and Michael L. Coco, PhD reported no financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity.

The faculty reported the following financial relationships or affiliations with commercial interests during the past 12 months:

David J. Rosenberg, MD, MPH, FACP, SFHM

Advisory Boardfor scientific information: Canyon Pharmaceuticals

Consultantfor marketing purposes: UCB

Grant Recipient/Research Support (PI; funds paid to Feinstein Institute): Sanofi‐Aventis

Promotional Speaker's Bureau: Sanofi‐Aventis

David R. Snydman, MD, FACP, FIDSA

Advisory Boardfor scientific information: CSL Behring, Genentech, Genzyme, Millenium, Novartis

Consultantfor clinical trial design: CSL Behring

Grant Recipient/Research Support (PI; funds paid to Tufts Medical Center): Cubist, Forest Pharmaceuticals, Johnson & Johnson, Merck & Co., Inc., Pfizer

Promotional Speaker's Bureau: CSL Behring, Merck & Co., Inc.

Keith S. Kaye, MD, MPH

Advisory Boardfor scientific information: Forest Pharmaceuticals, Merck & Co., Inc., Ortho‐McNeil, Pfizer, TheraDoc

Grant Recipient/Research Support (PI; funds paid to Wayne State University): Merck & Co., Inc., Pfizer

Promotional Speaker's Bureau: Cubist, Merck & Co., Inc., Ortho‐McNeil, Pfizer

Thomas M. File, Jr., MD, MSc, MACP, FIDSA, FCCP

Consultantfor clinical trial design: Cerexa/Forest Pharmaceuticals, Glaxo SmithKline, Merck & Co., Inc., Nabriva Therapeutics, Ortho‐McNeil, Protez/Novartis, Pfizer, Rib‐X Pharmaceuticals, Shire, Tetraphase Pharmaceuticals

Grant Recipient/Research Support (PI; funds paid to Suma Health System): Boehringer Ingelheim, Cerexa/Forest Pharmaceuticals, Gilead, Ortho‐McNeil, Pfizer, Tibotec

Independent clinical peer‐reviewer:

David Alland, MD

Professor of Medicine

Chief, Division of Infectious Disease

Interim Director, Center for Emerging and Re‐Emerging Pathogens

Assistant Dean for Clinical Research

University of Medicine and Dentistry of New JerseyThe New Jersey Medical School

Newark, New Jersey

PI for NIH STTR grant to Cepheid (to develop TB diagnostics)grant ended 9/10

Member, group of patent holders related to molecular beacon licenses

Employee (spouse): Bristol‐Myers Squibb

Shareholder/Stock options (self and spouse): Bristol‐Myers Squibb

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Faculty have been asked to disclose off‐label and/or investigational uses where they are mentioned. American Academy of CME (Academy), Global Education Exchange, Inc. (GLOBEX) and Merck & Co., Inc. do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the Academy, GLOBEX, Merck & Co., Inc, or any other manufacturer of pharmaceuticals or devices. Before prescribing any medication, physicians should consult primary references and full prescribing information. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, learners should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this activity.

In addition, the American Academy of CME requires all faculty/authors to note the level of evidence for any patient care recommendation they make.

Method of Participation:

There are no fees for participating and receiving CME credit for this activity. During the period January 9, 2012 through January 9, 2013, learners must 1) review the CME information including the learning objectives and disclosure statements; 2) study the educational content of the activity; 3) go online at http://tinyurl.com/INFECTIOUSAT, click on Assessment, and then register on the site (or login if you previously registered on the site). Upon successfully completing the posttest (with a passing score of 70% or better) and the activity evaluation, your certificate will be made available immediately to print online.

Media:

Journal supplement

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Contact Info:

For questions or comments about this CME activity, contact:

John JD Juchniewicz, MCIS, CCMEP

American Academy of CME

[email protected]

2012 American Academy of CME and Global Education Exchange, Inc.

Estimated time to complete the activity: 3 hours 30 minutes

Jointly sponsored by the American Academy of CME and Global Education Exchange, Inc

This activity is supported by an educational grant from Merck & Co., Inc.

There is no fee to participate in this CME‐certified activity.

Program Overview

Early and appropriate treatment of acute infections, especially in critically ill and immunocompromised patients, is paramount to successful outcomes. Appropriate empiric therapy often requires the use of multiple broad‐spectrum agents that must be used judiciously to preserve antimicrobial activity over time. Critical components of antimicrobial stewardship include the selection of appropriate antibiotics, de‐escalation of therapy after 2 or 3 days of empiric treatment, and a strategy for the duration and discontinuation of therapy. An evidence‐based approach to these essential stewardship factors will improve patient outcomes by decreasing unnecessary antimicrobial exposures and associated unwanted effects as well as reduce the risk for emergence of antimicrobial resistance.

The intent of this educational activity is to illustrate these components of antimicrobial stewardship in a practical, case‐based format. Since hospitalists and intensivists play a central role in the formation and operation of a successful antimicrobial stewardship program, special consideration will be given to strategies that they can apply in their daily practices.

Target Audience

This activity was designed to meet the needs of hospitalists and intensivists who are involved in the diagnosis, management, and treatment of infectious diseases in the hospital setting. Other healthcare professionals are also invited to participate.

Faculty and Topics

Empiric Antibiotic Selection Strategies for Healthcare‐Associated Pneumonia, Intra‐abdominal Infections, and Catheter‐Associated Bacteremia

David R. Snydman, MD, FACP, FIDSA

Chief, Division of Geographic Medicine and Infectious Diseases

Tufts Medical Center

Professor of Medicine

Tufts University School of Medicine

Boston, Massachusetts

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of CME, Inc. and Global Education Exchange, Inc. American Academy of CME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

American Academy of CME designates this enduring material for a maximum of 3.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflict of Interest

According to the disclosure policy of the American Academy of CME, all faculty, planning committee members, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials were reviewed for fair balance, scientific objectivity, and levels of evidence.

Academy planner John JD Juchniewicz, MCIS, CCMEP, and GLOBEX planners and editors Meri D. Pozo, PhD and Michael L. Coco, PhD reported no financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity.

The faculty reported the following financial relationships or affiliations with commercial interests during the past 12 months:

David J. Rosenberg, MD, MPH, FACP, SFHM

Advisory Boardfor scientific information: Canyon Pharmaceuticals

Consultantfor marketing purposes: UCB

Grant Recipient/Research Support (PI; funds paid to Feinstein Institute): Sanofi‐Aventis

Promotional Speaker's Bureau: Sanofi‐Aventis

David R. Snydman, MD, FACP, FIDSA

Advisory Boardfor scientific information: CSL Behring, Genentech, Genzyme, Millenium, Novartis

Consultantfor clinical trial design: CSL Behring

Grant Recipient/Research Support (PI; funds paid to Tufts Medical Center): Cubist, Forest Pharmaceuticals, Johnson & Johnson, Merck & Co., Inc., Pfizer

Promotional Speaker's Bureau: CSL Behring, Merck & Co., Inc.

Keith S. Kaye, MD, MPH

Advisory Boardfor scientific information: Forest Pharmaceuticals, Merck & Co., Inc., Ortho‐McNeil, Pfizer, TheraDoc

Grant Recipient/Research Support (PI; funds paid to Wayne State University): Merck & Co., Inc., Pfizer

Promotional Speaker's Bureau: Cubist, Merck & Co., Inc., Ortho‐McNeil, Pfizer

Thomas M. File, Jr., MD, MSc, MACP, FIDSA, FCCP

Consultantfor clinical trial design: Cerexa/Forest Pharmaceuticals, Glaxo SmithKline, Merck & Co., Inc., Nabriva Therapeutics, Ortho‐McNeil, Protez/Novartis, Pfizer, Rib‐X Pharmaceuticals, Shire, Tetraphase Pharmaceuticals

Grant Recipient/Research Support (PI; funds paid to Suma Health System): Boehringer Ingelheim, Cerexa/Forest Pharmaceuticals, Gilead, Ortho‐McNeil, Pfizer, Tibotec

Independent clinical peer‐reviewer:

David Alland, MD

Professor of Medicine

Chief, Division of Infectious Disease

Interim Director, Center for Emerging and Re‐Emerging Pathogens

Assistant Dean for Clinical Research

University of Medicine and Dentistry of New JerseyThe New Jersey Medical School

Newark, New Jersey

PI for NIH STTR grant to Cepheid (to develop TB diagnostics)grant ended 9/10

Member, group of patent holders related to molecular beacon licenses

Employee (spouse): Bristol‐Myers Squibb

Shareholder/Stock options (self and spouse): Bristol‐Myers Squibb

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Faculty have been asked to disclose off‐label and/or investigational uses where they are mentioned. American Academy of CME (Academy), Global Education Exchange, Inc. (GLOBEX) and Merck & Co., Inc. do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the Academy, GLOBEX, Merck & Co., Inc, or any other manufacturer of pharmaceuticals or devices. Before prescribing any medication, physicians should consult primary references and full prescribing information. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, learners should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this activity.

In addition, the American Academy of CME requires all faculty/authors to note the level of evidence for any patient care recommendation they make.

Method of Participation:

There are no fees for participating and receiving CME credit for this activity. During the period January 9, 2012 through January 9, 2013, learners must 1) review the CME information including the learning objectives and disclosure statements; 2) study the educational content of the activity; 3) go online at http://tinyurl.com/INFECTIOUSAT, click on Assessment, and then register on the site (or login if you previously registered on the site). Upon successfully completing the posttest (with a passing score of 70% or better) and the activity evaluation, your certificate will be made available immediately to print online.

Media:

Journal supplement

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Contact Info:

For questions or comments about this CME activity, contact:

John JD Juchniewicz, MCIS, CCMEP

American Academy of CME

[email protected]

2012 American Academy of CME and Global Education Exchange, Inc.

Estimated time to complete the activity: 3 hours 30 minutes

Jointly sponsored by the American Academy of CME and Global Education Exchange, Inc

This activity is supported by an educational grant from Merck & Co., Inc.

There is no fee to participate in this CME‐certified activity.

Program Overview

Early and appropriate treatment of acute infections, especially in critically ill and immunocompromised patients, is paramount to successful outcomes. Appropriate empiric therapy often requires the use of multiple broad‐spectrum agents that must be used judiciously to preserve antimicrobial activity over time. Critical components of antimicrobial stewardship include the selection of appropriate antibiotics, de‐escalation of therapy after 2 or 3 days of empiric treatment, and a strategy for the duration and discontinuation of therapy. An evidence‐based approach to these essential stewardship factors will improve patient outcomes by decreasing unnecessary antimicrobial exposures and associated unwanted effects as well as reduce the risk for emergence of antimicrobial resistance.

The intent of this educational activity is to illustrate these components of antimicrobial stewardship in a practical, case‐based format. Since hospitalists and intensivists play a central role in the formation and operation of a successful antimicrobial stewardship program, special consideration will be given to strategies that they can apply in their daily practices.

Target Audience

This activity was designed to meet the needs of hospitalists and intensivists who are involved in the diagnosis, management, and treatment of infectious diseases in the hospital setting. Other healthcare professionals are also invited to participate.

Faculty and Topics

Empiric Antibiotic Selection Strategies for Healthcare‐Associated Pneumonia, Intra‐abdominal Infections, and Catheter‐Associated Bacteremia

David R. Snydman, MD, FACP, FIDSA

Chief, Division of Geographic Medicine and Infectious Diseases

Tufts Medical Center

Professor of Medicine

Tufts University School of Medicine

Boston, Massachusetts

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of CME, Inc. and Global Education Exchange, Inc. American Academy of CME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

American Academy of CME designates this enduring material for a maximum of 3.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflict of Interest

According to the disclosure policy of the American Academy of CME, all faculty, planning committee members, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials were reviewed for fair balance, scientific objectivity, and levels of evidence.

Academy planner John JD Juchniewicz, MCIS, CCMEP, and GLOBEX planners and editors Meri D. Pozo, PhD and Michael L. Coco, PhD reported no financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity.

The faculty reported the following financial relationships or affiliations with commercial interests during the past 12 months:

David J. Rosenberg, MD, MPH, FACP, SFHM

Advisory Boardfor scientific information: Canyon Pharmaceuticals

Consultantfor marketing purposes: UCB

Grant Recipient/Research Support (PI; funds paid to Feinstein Institute): Sanofi‐Aventis

Promotional Speaker's Bureau: Sanofi‐Aventis

David R. Snydman, MD, FACP, FIDSA

Advisory Boardfor scientific information: CSL Behring, Genentech, Genzyme, Millenium, Novartis

Consultantfor clinical trial design: CSL Behring

Grant Recipient/Research Support (PI; funds paid to Tufts Medical Center): Cubist, Forest Pharmaceuticals, Johnson & Johnson, Merck & Co., Inc., Pfizer

Promotional Speaker's Bureau: CSL Behring, Merck & Co., Inc.

Keith S. Kaye, MD, MPH

Advisory Boardfor scientific information: Forest Pharmaceuticals, Merck & Co., Inc., Ortho‐McNeil, Pfizer, TheraDoc

Grant Recipient/Research Support (PI; funds paid to Wayne State University): Merck & Co., Inc., Pfizer

Promotional Speaker's Bureau: Cubist, Merck & Co., Inc., Ortho‐McNeil, Pfizer

Thomas M. File, Jr., MD, MSc, MACP, FIDSA, FCCP

Consultantfor clinical trial design: Cerexa/Forest Pharmaceuticals, Glaxo SmithKline, Merck & Co., Inc., Nabriva Therapeutics, Ortho‐McNeil, Protez/Novartis, Pfizer, Rib‐X Pharmaceuticals, Shire, Tetraphase Pharmaceuticals

Grant Recipient/Research Support (PI; funds paid to Suma Health System): Boehringer Ingelheim, Cerexa/Forest Pharmaceuticals, Gilead, Ortho‐McNeil, Pfizer, Tibotec

Independent clinical peer‐reviewer:

David Alland, MD

Professor of Medicine

Chief, Division of Infectious Disease

Interim Director, Center for Emerging and Re‐Emerging Pathogens

Assistant Dean for Clinical Research

University of Medicine and Dentistry of New JerseyThe New Jersey Medical School

Newark, New Jersey

PI for NIH STTR grant to Cepheid (to develop TB diagnostics)grant ended 9/10

Member, group of patent holders related to molecular beacon licenses

Employee (spouse): Bristol‐Myers Squibb

Shareholder/Stock options (self and spouse): Bristol‐Myers Squibb

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Faculty have been asked to disclose off‐label and/or investigational uses where they are mentioned. American Academy of CME (Academy), Global Education Exchange, Inc. (GLOBEX) and Merck & Co., Inc. do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the Academy, GLOBEX, Merck & Co., Inc, or any other manufacturer of pharmaceuticals or devices. Before prescribing any medication, physicians should consult primary references and full prescribing information. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, learners should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this activity.

In addition, the American Academy of CME requires all faculty/authors to note the level of evidence for any patient care recommendation they make.

Method of Participation:

There are no fees for participating and receiving CME credit for this activity. During the period January 9, 2012 through January 9, 2013, learners must 1) review the CME information including the learning objectives and disclosure statements; 2) study the educational content of the activity; 3) go online at http://tinyurl.com/INFECTIOUSAT, click on Assessment, and then register on the site (or login if you previously registered on the site). Upon successfully completing the posttest (with a passing score of 70% or better) and the activity evaluation, your certificate will be made available immediately to print online.

Media:

Journal supplement

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Contact Info:

For questions or comments about this CME activity, contact:

John JD Juchniewicz, MCIS, CCMEP

American Academy of CME

[email protected]

2012 American Academy of CME and Global Education Exchange, Inc.