Carolinas HealthCare System
Lisa Davidson, MD

Lisa Davidson, MD
Medical Director of the
Antimicrobial Support Network

Carolinas HealthCare System's Antimicrobial Support Network (ASN), an antibiotic stewardship program, recently expanded to multiple facilities in order to support clinicians in making the best choices when prescribing antimicrobials for their patients. Misuse of antibiotics is common and has created an international health problem.

"Overprescribing and inappropriate use of antibiotics are leading to rising antibiotic resistance, which is associated with rising mortality, morbidity and an increase in hospital-acquired infections," said Lisa Davidson, MD, medical director of the System's Antimicrobial Support Network. "A recent Centers for Disease Control and Prevention (CDC) report characterized our increasing antimicrobial resistance as an urgent crisis that requires immediate attention. Stewardship is one of the key interventions to prevent worsening resistance in our community. Hence, the ASN was created to advise clinicians and pharmacists across the System in the selection, dosage and duration of antimicrobial therapies."

In 2012 and 2013, 65 to 70 percent of inpatient adults and 25 to 30 percent of inpatient pediatric patients received an antibiotic during their stay at Carolinas Medical Center. Antibiotics are typically used to treat invasive infections and illnesses caused by bacteria. However, the CDC estimates that more than 50 percent of inpatient antibiotics are unnecessary.

Stewardship programs have launched across the nation to combat this public health issue and have shown positive results, such as increased rates of clinical cure and decreased rates of treatment failure.

In 2009, Carolinas HealthCare System successfully launched stewardship programs at Carolinas HealthCare System NorthEast and Carolinas HealthCare System Union. For example, the ASN efforts at Carolinas HealthCare System NorthEast decreased anti-pseudomonal carbapenem use by 47 percent and tigecycline use by 86 percent.

The ASN is a team of physicians and pharmacists specifically trained to assist clinicians in appropriate antibiotic use. Each day, stewardship pharmacists identify patients who are candidates for an intervention, which is then reviewed with the ASN's stewardship physician. The recommendation is then communicated to the patient's clinician. In addition, the ASN team is available Monday through Friday to provide real-time advice on empiric therapy, national and System-focused treatment guidelines, and appropriate drug dosing.

"Clinicians are very receptive to the calls from the stewardship team," said Dr. Davidson. "Our ultimate goal is to support clinicians in providing top quality patient care and safety."

The ASN is currently available at the following locations:

  • Carolinas Medical Center
  • Carolinas HealthCare System NorthEast
  • Carolinas HealthCare System Pineville
  • Carolinas HealthCare System Union
  • CMC-University
  • CMC-Mercy: launching Jan. 7

The ASN will continue to roll-out throughout the System in 2014 and 2015, with the goal of providing a System-wide antibiotic stewardship network by the end of 2015.

In November, the ASN partnered with the CDC during its annual antibiotics awareness campaign, Get SMART about Antibiotics week, providing information, resources and support throughout the System.

Get SMART about Antibiotics"Get SMART week was a great opportunity for the ASN to inform clinicians about appropriate antibiotic use and how we can support them with this process," said Dr. Davidson. "The campaign was a great success."

To learn more about the Antimicrobial Support Network and its involvement with "Get SMART about Antibiotics," please visit the Infectious Disease page on PhysicianConnect or view the short PowerPoint presentation.

*Note: To view the video, you must be on the Carolinas HealthCare System network.

View Carolinas Medical Center's downloadable PDF of the ASN handout