Carolinas HealthCare System
Nehal P. Thakkar, MD

Lisa Davidson, MD, Medical Director of Carolinas HealthCare System's
Antimicrobial Support Network. 

When used properly, antibiotics are effective medicines that can be used to save lives. However, when not used appropriately, antibiotics can lose effectiveness and contribute to the emergence of multidrug-resistant infections.

In order to provide the best possible clinical outcomes to patients while minimizing adverse events and antimicrobial resistance, Carolinas HealthCare System has implemented the Antimicrobial Support Network. The ASN team, led by Lisa Davidson, MD, recently partnered with the CDC and the North Carolina Hospital Association to raise awareness about the overutilization of antibiotics during Get Smart About Antibiotics Week.

“The inappropriate utilization of antibiotics is an issue that affects all patients throughout our healthcare continuum. Every day we have pharmacists who review inpatient antibiotic orders and determine whether those orders are appropriate based on the patient’s clinical status and work-up of infection,” Dr. Davidson said. “If they think a change in antimicrobials would be appropriate, those recommendations are discussed with an Infectious Disease physician. The ASN team then contacts the patient’s clinician to make a recommendation.”

Launched in August, 2013, the ASN has shown:

  • A System-wide decrease of antimicrobial days of therapy of 9.4 percent
  • A System-wide decrease in antimicrobial purchasing of 11 percent
  • An intervention acceptance rate of 85 percent

An ASN recommendation can include: stopping a patient’s antibiotics based on culture results or clinical findings, completion of a patient’s antibiotic course based on indication, decreasing the number of antibiotics a patient is prescribed, switching a patient  to a more targeted or effective antimicrobial, or expanding  the patient’s antimicrobial coverage to cover potentially multidrug-resistant organisms.

The ASN is currently operating at six System hospitals. In 2015, the ASN will expand to Carolinas HealthCare System Lincoln, Carolinas Medical Center-Cleveland, Kings Mountain Hospital and Carolinas Rehabilitation.

In addition, this year ASN participated in a Leading Edge Advanced Practice Topics grant to assess antimicrobial utilization in skilled nursing facilities and ways to improve discharge planning for patients going home on intravenous antibiotics.