Antimicrobial approval pager and new ID pharmacist

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GLA now (again) has a dedicated antibiotic approval pager:

VA pager 73022

Two ways to access:

1.       From VA phone: *11, then 73022, enter in callback number

2.       Via internet text message: https://secure.usamobility.net/ (TEXT MESSAGE MUST INCLUDE CALLBACK NUMBER)

All requests for restricted antimicrobial use will be reviewed/approved Monday through Friday 8AM-4:30PM, either by our new ID pharmacist Phuong Nguyen or an ID fellow on an antimicrobial stewardship rotation.  In addition to having Phuong as an ID pharmacotherapy resource, please also consult the VA-GLA Infectious Diseases website (www.vaglaid.org) for clinical guidance on the use of antimicrobials and other valuable ID-related resources.

Other notes:

§  Antimicrobials at GLA are classified as unrestricted, restricted by guideline or always require approval. As such, many restricted antimicrobials are available without prior approval for use in accordance with GLA ID guidelines to treat specified infections.

§  During nights and weekends, pharmacy can release restricted antimicrobials pending ID approval (obtain via consult pager UCLA 89321). For continued therapy, such approval must be received by 11 AM on the next day.

§  Can still send e-consults for less urgent approvals, particularly after-hours and on weekends.

Link to VA-GLA Infectious Diseases Site: http://www.vaglaid.org/

ID Pharmacy Contact:

Phuong Nguyen, PharmD

Ext. 47057

Pager Number: 73022

New C. difficile guidelines and order sets!

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The Infectious Diseases Society of America guidelines on the management of Clostridium difficile-associated disease have been recently updated.  The most notable change in recommendations from prior guidelines is that oral metronidazole is no longer a first-line option in the management of mild-to-moderate disease. 

Our local guidelines (available under the Guidelines/GLA Guidelines link above) have been updated accordingly.  Both the standard 10-14d course of oral vancomycin for initial disease and oral vancomycin tapers for recurrent disease no longer require approval from the Infectious Diseases service.  We have also created order sets for management of C. difficile in the "Outpatient Antibiotic Protocols" and "Inpatient Antibiotic Protocols" order sets that are available within most CPRS order sets.  The ID service highly encourages use of the antibiotic protocol order sets, as they are routinely updated to be consistent with local and national guidelines for management of common infectious conditions.

GLA will also be soon be participating in a VA Cooperative Studies Program study in which patients with first recurrence of C. difficile disease will be randomized to receive a standard vs. tapering vancomycin course vs. fidaxomicin.  More details to follow.

New GLA antibiogram!

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Our 2017 antibiogram, which compiles antimicrobial resistance data from GLA isolates from the calendar year 2017 is now available here.  Overall resistance patterns are largely stable to slightly improved compared to 2016.  Notable findings include:

For Gram-negative rods in the hospital setting:

  • Amikacin remains the most active agent vs. multi-drug resistant Gram-negative rod infections at GLA.
  • Carbapenem-resistant Enterobacteriaceae remain somewhat uncommon at GLA.
  • There is not much overall difference between piperacillin-tazobactam, cefepime, and meropenem for most Enterobacteriaceae and Pseudomonas (but all are better than fluoroquinolones)
  • Pseudomonas is less frequently encountered in the urine as compared to other sites.

For Gram-negative rods in the outpatient setting:

  • Cepahlexin remains our first-line option for outpatient UTI treatment (the 92% susceptiblity rate of outpatient urinary E. coli to cefazolin may actually underestimate urinary cephalexin susceptibility as urinary breakpoints are higher than serum).
  • Fluoroquinolones and TMP-SMX susceptibility rates for urinary isolates are similar (~75-80%).

For Gram-positive rods:

  • MRSA remains common (~60% of nosocomial isolates and ~40% of outpatient isolates).
  • Doxycycline resistance is increasing among non-blood nosocomial S. aureus isolates (30%).

CDC Antibiotic Awareness Week: November 13-17, 2017

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