Northwestern Medicine Antimicrobial Stewardship

Welcome to Northwestern Medicine Antimicrobial Stewardship

Center of Excellence: Northwestern Memorial Hospital

Our Mission

To ensure that our patients receive the safest and most effective antimicrobial therapy for their infection while preserving and protecting the effectiveness of these endangered resources for future patients.

New Vancomycin Clinical Update

Initiative: Convert from trough level to AUC* monitoring for all patients receiving intravenous vancomycin at Northwestern Memorial Hospital.

Goal: To reduce rates of nephrotoxicity associated with vancomycin use.

Rationale:

Vancomycin trough levels are not strongly correlated with antibiotic efficacy.
Monitoring AUC improves patient safety by reducing nephrotoxicity risks in patients receiving intravenous vancomycin.
Upcoming IDSA vancomycin dosing guidelines anticipated to recommend monitoring by AUC methodology.

Procedure:

Trough levels will continue to be obtained as the NMH standard of care.
Pharmacists will convert the trough levels to an AUC estimate using single level population pharmacokinetics and document in a progress note.
AUC target range = 350-600 mg*h/L

Resources:

User Guide for Vancomycin AUC Calculator
Online AUC Calculator (see above guide for tutorial)
For questions or support please page the NMH Antimicrobial Stewardship Team at 55955.

*AUC - area under the concentration-time curve.

CDC Global Antimicrobial Resistance Challenge

"Northwestern Medicine, an integrated academic health system in the Chicago area with 4,000 physicians and 30,000 employees caring for over 1.1 million patients, is committed to improving antibiotic use to ensure that these important medications remain effective treatment options. The Antimicrobial Stewardship Quality Committee commits to using local and CDC data to reduce unnecessary antibiotic use across their system. They also commit to increased use of penicillin allergy testing to remove misdiagnoses and decrease the use of broader-spectrum antibiotics. Utilizing both of these interventions will be aimed at reducing overly broad spectrum antibiotic use and emphasize their strong commitment to better patient care and combating antibiotic resistance."

See "Northwestern Medicine" on the CDC AMR Challenge Website

Antibiotic Awareness Resources

Our NM Antimicrobial Stewardship Team works continuously to support our clinicians in their decision to prescribe antibiotic orders. Please reach out to your NM hospital's antibiotic stewardship team for resources and clinical decision support. Visit our team page here.

CDC reports over 2 million illnesses and 23,000 deaths annually from infections that are resistant to antibiotics
Antibiotic resistance adds $20 billion in excess direct health care costs, $35 billion societal costs for lost productivity
The use of antibiotics is the single most important factor leading to resistance
Nearly 50% of all antibiotics ordered in hospitals are not needed or inappropriate prescribed
At least 30% of antibiotics in U.S. outpatient settings are prescribed unnecessarily
Fighting antibiotic resistance is a public health and national security priority

Antibiotic Awareness Resources

Safety Updates

FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients (FDA Announcement)