CASP Resources
Carolina Antimicrobial Stewardship Program (CASP) publications and presentations are intended to improve our understanding of stewardship, document what works, and provide tools to aid in implementation of stewardship activities.
UNC Medical Center Resources
Note: The resources below may require UNC Health login and/or may only be accessed from the UNCMC/UNC campus.
Featured Resources
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- Updated Influenza Treatment Guideline (version: 12/2021)
- New Terminology Change to Vancomycin Infusion Reaction from Red Man Syndrome (2021)
- Background on why it matters and what you can do
- How to document in Epic
- Best Practices for Shortest Effective Antimicrobial Durations (version: 8/2020)
- Diagnosis and Management of Clostridioides difficile Infection in Adult and Pediatric Patients (version: 12/20)
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UNC Medical Center Antibiogram
- Updated 2020 Antibiogram
UNC Medical Center Antimicrobial Use Guidance
- Restricted Anti-Infective Drugs – Adult & Pediatric (version: 10/2021)
- Best Practices for Duration of Antimicrobial Therapy for Infectious Syndromes (version: 8/2020)
- Guidance for the empiric use of restricted β-lactams with activity against carbapenem-resistant Enterobacterales (CRE) (version: 9/2020)
- Carbapenem Use Guideline (version: 7/2020)
- Rapid Gram-Positive Diagnostic Testing Guideline (version: 6/2021)
- Surgical Prophylaxis:
- Antimicrobial Surgical Prophylaxis Guidelines – Adult (version: 5/2020)
- Perioperative Antibiotic Protocol (version: 5/2019)
UNC Medical Center Clinical Syndrome Treatment Guidelines
- Urinary Tract Infection (UTI) Guideline (version: 8/2021)
- Community Acquired Pneumonia Guideline (version: 6/2020)
- Hospital Acquired Pneumonia Guideline (version: 6/2020)
- Protocol for Managing Hypokalemia in patients enrolled in the UNC Medical Center’s OPAT Program (version: 3/2020)
- Antibiotic Locks for the Treatment or Prevention of Catheter-Related Bloodstream Infections (version: 2/2020)
- Bloodstream Infection Management Candida (version: 8/2019)
- Bloodstream Infection Management S. aureus (version: 8/2019)
- Vancomycin Resistant Enterococcus (VRE) Treatment (version: 6/2019)
- C. difficile Infection Prevention Workbook, includes detailed data on CDI (updated monthly)
UNC Medical Center Antimicrobial Dosing and Monitoring Resources
- Renal insufficiency and hemodialysis antimicrobial dosing guideline (version: 6/2021)
- Laboratory Monitoring Guideline for Outpatient Parenteral and Oral Antimicrobial Therapy for Pediatrics & Adults (version:5/2021)
- Parenteral Vancomycin and Aminoglycoside Dosing Protocol for Pharmacists – Adult & Pediatric (version:11/2020)
- Antibiotic CVVH/CVVHD Dosing Recommendations (version: 5/2020)
- Amioglycoside Dosing & Monitoring Guidelines (version: 12/2019)
- Vancomycin Dosing Guidelines (Adult) (version: 11/2019)
- Susceptible Dose Dependent (SDD) Dosing: Daptomycin and Ceftaroline (version: 6/2019)
- Azole Antifungal Therapeutic Drug Monitoring Guidelines (version: 5/2019)
UNC Children’s Hospital Stewardship Resources
- Assessment and Management of Hospital-acquired and Ventilator-associated Pneumonia in Children (version: 9/2021)
- Empiric Acyclovir Treatment (<90 days of age) Guideline (version: 4/2021)
- Pediatric Community-Acquired Pneumonia Clinical Practice Guideline (version: 2/2021)
- Pediatric ED UTI Clinical (undated)
- Rapid Gram-Positive Diagnostic Testing Guideline (version: 6/2020)
- Neonatal and Pediatric Vancomycin Dosing Guideline (version: 2/2020)
- Diagnosis and Management of Influenza at UNC Children’s Hospital (version: 12/2019)
- Antimicrobial Therapy of Pediatric Community Acquired Pneumonia at UNC (version: 12/2019)
- Neonatal and Pediatric Aminoglycoside Dosing Guideline (version: 11/2019)
- Surgical Prophylaxis (version: 4/2019)
- Pediatric Musculoskeletal Infections (version: 11/2018)
Other UNC Medical Center Resources
- Penicillin Allergy Assessment Tool Kit (version: 3/2021)
- Antibiotic Time-outs Readiness Checklist (version: 10/2020)
- Removing Patients from Isolation
- Isolation Policies (version: 4/2021)
Publications
2021
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Vaz LE, Felder KK, Newland JG, Hersh AL, Rajapakse NS, Willis ZI, Banerjee R, Gerber JS, Schwenk HT, Wang ME. A National Survey of Outpatient Parenteral Antibiotic Therapy Practices. J Pediatric Infect Dis Soc. 2021 Dec 23:piab127. doi: 10.1093/jpids/piab127. Epub ahead of print. PMID: 34939654.
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Ciccone EJ, Kabugho L, Baguma E, Muhindo R, Juliano JJ, Mulogo E, Boyce RM. Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda. Microbiol Spectr. 2021 Dec 22;9(3):e0169421. doi: 10.1128/Spectrum.01694-21. Epub 2021 Nov 24. PMID: 34817224; PMCID: PMC8612158.
- Ly WJ, Brown EE, Pedretti Z, Auten J, Wilson WS. Evaluation of early de-escalation of empiric antimicrobial therapy in acute leukemia patients with febrile neutropenia at a large academic medical center. J Oncol Pharm Pract 2021. doi: 10.1177/10781552211067776
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Assimon MM, Pun PH, Wang LC, Al-Khatib SM, Brookhart MA, Weber DJ, Winkelmayer WC, Flythe JE. Analysis of Respiratory Fluoroquinolones and the Risk of Sudden Cardiac Death Among Patients Receiving Hemodialysis. JAMA Cardiol. 2021 Oct 20. doi: 10.1001/jamacardio.2021.4234. Epub ahead of print. PMID: 34668928.
- Katawethiwong P, Apisarnthanarak A, Jantarathaneewat K, Weber DJ, Warren DK, Suwantarat N. Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study. Infect Control Hosp Epidemiol. 2021 Jul 12:1-6. doi: 10.1017/ice.2021.296. Epub ahead of print. PMID: 34247663.
- Spicer JO, Armstrong WS, Schwartz BS, et al.: The IDSA Antimicrobial Stewardship Curriculum Workgroup. Evaluation of the Infectious Diseases Society of America’s Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows. Clinical Infectious Diseases. 2021;(ciab600). doi:10.1093/cid/ciab600
- Apisarnthanarak A, Weber DJ. Strategy to limit multidrug-resistant Acinetobacter baumannii transmission in a cohort coronavirus disease 2019 (COVID-19) critical care unit. Infect Control Hosp Epidemiol. 2021 Jun 24:1-2. doi: http://10.1017/ice.2021.289
- Willis ZI, de St Maurice A. A Piece of the Puzzle: The Role of Molecular Testing in Antimicrobial Stewardship. J Pediatric Infect Dis Soc. 2021 Jun 15:piab037. doi: 10.1093/jpids/piab037.
- Seidelman JL, Moehring RW, Weber DJ, Anderson DJ, Lewis SS. The impact of patient-reported penicillin or cephalosporin allergy on surgical site infections. Infect Control Hosp Epidemiol. 2021 Jun 9:1-5. doi: https://doi.org/10.1017/ice.2021.232
- Ross RK, Gerber JS, Willis ZI, Hersh AL, Kinlaw AC. Outpatient Fluoroquinolone Use in Children, 2000-2018. J Pediatric Infect Dis Soc. 2021 May 28;10(5):576-585. doi: 10.1093/jpids/piaa156.
- Jantarathaneewat K, Apisarnthanarak A, Limvorapitak W, Weber DJ, Montakantikul P. Pharmacist-Driven Antibiotic Stewardship Program in Febrile Neutropenic Patients: A Single Site Prospective Study in Thailand. Antibiotics (Basel). 2021 Apr 17;10(4):456. doi: http://10.3390/antibiotics10040456
- Luther VP, Shnekendorf R, Logan A, et al.: The IDSA Antimicrobial Stewardship Curriculum Workgroup. Investing in the Future: A Role for Professional Societies to Prepare the Next Generation of Healthcare Leaders through Curriculum Development and Dissemination. Clinical Infectious Diseases. 2021;(ciab244). doi:10.1093/cid/ciab244
- Garner L, Ngo Susan, Kaplan JB, Wilson WS, and McKinzie CJ. Evaluation of posaconazole dosing in children and young adults: a single-center review. J Pediatr Pharmacol Ther. 2021;26(8):834-840. doi: 10.5863/1551-6776-26.8.834
- Garcia Reeves AB, Trogdon JG, Stearns SC, Lewis JW, Weber DJ, Weinberger M. Are Rates of Methicillin-Resistant Staphylococcus aureus and Clostridioides difficile Associated With Quality and Clinical Outcomes in US Acute Care Hospitals? Am J Med Qual. 2021 Mar-Apr 01;36(2):90-98. doi: http://10.1177/1062860620942310
- Garcia Reeves AB, Stearns SC, Trogdon JG, Lewis JW, Weber DJ, Weinberger M. Impact of California’s mandate for antimicrobial stewardship programs on rates of methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection in acute-care hospitals. Infect Control Hosp Epidemiol. 2021 Mar;42(3):298-304. doi: http://10.1017/ice.2020.446
2020
- OPAT Delivery during COVID-19. Michael J Swartwood, BSN, RN, CAPM, Renae A Boerneke, PharmD, BCPS, Alan C Kinlaw, PhD, Nikolaos Mavrogiorgos, MD, Ashley Marx, PharmD, Emily J Ciccone, MD, MHS, Asher J Schranz, MD, Mary C Bowman, MD, PhD, Claire E Farel, MD, MPH. Open Forum Infectious Diseases, Volume 7, Issue Supplement_1, October 2020, Page S308, https://doi.org/10.1093/ofid/ofaa439.676 Published: 31 December 2020
- Identifying Intervention Opportunities to Prevent Readmissions during OPAT. Michael J Swartwood, BSN, RN, CAPM, Claire E Farel, MD, MPH, Nikolaos Mavrogiorgos, MD, Renae A Boerneke, PharmD, BCPS, Ashley Marx, PharmD, Open Forum Infectious Diseases, Volume 7, Issue Supplement_1, October 2020, Page S365, https://doi.org/10.1093/ofid/ofaa439.801 Published: 31 December 2020
- Post-discharge Care Coordination Telephone Call for Patients Enrolled in the UNC OPAT Program. Renae A Boerneke, PharmD, BCPS, Michael J Swartwood, BSN, RN, CAPM, Alan C Kinlaw, PhD, Anita Holt, RN, Nikolaos Mavrogiorgos, MD, Open Forum Infectious Diseases, Volume 7, Issue Supplement_1, October 2020, Page S370, https://doi.org/10.1093/ofid/ofaa439.812 Published: 31 December 2020
- Kinlaw AC, Marx AH, Farel CE. Bias-Corrected Estimates of Time-Varying Adverse Drug Event Rates for Patients on Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis. 2018 Jul 2;67(2):316-318. doi: 10.1093/cid/ciy104.
- Cawcutt KA, Patel R, Gerber J, Caliendo AM, Cosgrove SE, Ashley ED, Garzaro P, Miller M, Lautenbach E; IDSA Research Summit ‘Leveraging Existing and Novel Diagnostics for Optimizing Outpatient Antibiotic Stewardship in Patients with Respiratory Tract Infections’ Group. Leveraging Existing and Soon-to-Be-Available Novel Diagnostics for Optimizing Outpatient Antibiotic Stewardship in Patients with Respiratory Tract Infections. Clin Infect Dis. 2020 Dec 4:ciaa1815. doi: 10.1093/cid/ciaa1815. Epub ahead of print.
- Parr JB.Time to Reassess Tocilizumab’s Role in COVID-19 Pneumonia. JAMA Intern Med. Published online October 20, 2020. doi:10.1001/jamainternmed.2020.6557
- Willis ZI, Wilson WS. Revised Daptomycin Interpretation Criteria for Enterococcus faecium: What Are the Implications for Children? J Pediatric Infect Dis Soc. 2020;9(2):265-267. doi:10.1093/jpids/piz066
- Daniels LM, Weber DJ. Interventions to improve antibiotic prescribing at hospital discharge: A systematic review. Infection Control and Hospital Epidemiology 2020 Sept 1: 1-4 doi: 10.1017/ice.2020.367
- Layton JB, McGrath LJ, Sahrmann JM, Ma Y, Dharnidharka VR, O’Neil C, Weber DJ, Butler AM. Comparative safety of high-dose versus standard-dose influenza vaccination in patients with end-stage renal disease. Vaccine. 2020 Jul 14;38(33):5178-5186.
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Rhea S, Jones K, Endres-Dighe S, Munoz B, Weber DJ, Hilscher R, MacFarquhar J, Sickbert-Bennett E, DiBiase L, Marx A, Rineer J, Lewis J, Bobashev G. Modeling inpatient and outpatient antibiotic stewardship interventions to reduce the burden of Clostridioides difficile infection in a regional healthcare network. PLoS One. 2020;15(6):e0234031. Published 2020 Jun 11. doi:10.1371/journal.pone.0234031
Carolina Antimicrobial Stewardship Posters & Presentations
- Mackenzie Warner, Sydney Browder, Michael Swartwood, Nikolaos Mavrogiorgos, Howard Kashefsky, Ashley Marx. (2020). Patients Treated for Lower Extremity Osteomyelitis in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program.
- Renae Boerneke, Michael Swartwood, Alan Kinlaw, Anita Holt, Nikolaos Mavrogiorgos, Ashley H Marx, Emily Ciccone, Asher Schranz, Mary Catherine Bowman, Claire Farel. (2020, Oct. 21). Post-discharge Coordination Telephone Outreach for Patients Enrolled in the UNC OPAT Program. [Poster Presentation]. ID Week 2020, Philadelphia, PA, United States.
- Michael Swartwood, Claire Farel, Renae Boerneke, Nikolaos Mavrogiorgos, Ashley Marx, Asher Schranz, Emily Ciccone, Mary Catherine Bowman, Alan Kinlaw. (21 Oct 2020).Identifying Intervention Opportunities to Prevent Readmissions during OPAT. [Poster Presentation]. ID Week 2020, Philadelphia, PA, United States.
Michael Swartwood, Renae Boerneke, Alan Kinlaw, Nikolaos Mavrogiorgos, Ashley Marx, Emily Ciccone, Asher Schranz, Mary Catherine Bowman, Claire Farel. (21 Oct 2020).OPAT Delivery during COVID-19. [Poster Presentation]. ID Week 2020, Philadelphia, PA, United States.- Asher Schranz, Alan Kinlaw, Michael Swartwood, Ashley Marx, Renae Boerneke, Tenesha Medlin, Erin Mays, Claire E. Farel. OPAT at the End of Life?: Short and Long-Term Mortality Following Outpatient Parenteral Antibiotic Therapy. Open Forum Infectious Diseases, Volume 6, Issue supplement 2, 23 October 2019, Page S383, https://doi.org/10.1093/ofid/ofz360.944
- Bobbi Jo Walston, Lisa Fletcher, William Wilson, Renae Boerneke, Ashley Marx, John Vargas, Claire Farel. Implementation of a Pharmacist-led Intervention for Infectious Diseases Patients Discharged on Antimicrobials: the Infectious Diseases Discharge Outreach and Retention (ID DOOR) Program. Open Forum Infectious Diseases, Volume 6, Issue supplement 2, 23 October 2019, Pages S333–S334, https://doi.org/10.1093/ofid/ofz360.815
- Walker Mason, Alan Kinlaw, Emily Ciccone, Kevin Alby, Melissa Miller, Lindsay Daniels. Implementation of rapid diagnostic testing and antimicrobial stewardship interventions to reduce time to optimal therapy for Staphylococcus aureus bacteremia. October 2019 (Poster requires UNC Health log in.) Summary: This was a successful multidisciplinary collaborative project implementing rapid diagnostic testing and antimicrobial stewardship interventions to reduce time to optimal antimicrobial therapy for patients with for S. aureus bacteremia.
- Zach Willis, May-Britt Sten, Ronald Davis, Donna Krzastek, Lindsay Daniels, Jon Juliano, Clare Mock, Michael Swartwood, and Will Stanley. Implementation of Antibiotic Time Outs at UNC Medical Center. October 2019.
- Emily Ciccone, Alan C. Kinlaw, Wilbur Woodhouse, Vahini Chundi, Melissa B. Miller, David J. Weber, Jonathan J. Juliano, Ravi Jhaveri, and Zachary Willis on behalf of the UNC Medical Center Carolina Antimicrobial Stewardship Program. Respiratory Viral Testing and Antimicrobial De-escalation Among Hospitalized Patients at a Tertiary Care Facility, 2015-2016: A Matched Cohort Study Series. Open Forum Infectious Diseases, Volume 6, Issue supplement 2, 23 October 2019, Page S986, https://doi.org/10.1093/ofid/ofz360.2467
- Ashley Marx, Vahini Chundi, Jill Zaccardelli, Jon Oriet, Tim Angle, Michael Swartwood, Lindsay Daniels, Ross Boyce, Jonathan Juliano. Effects of An Antimicrobial Stewardship Team-led Staphylococcus aureus Bacteremia Management Bundle: A Quasi-Experimental Study. Open Forum Infectious Diseases, Volume 6, Issue supplement 2, 23 October 2019, Page S366, https://doi.org/10.1093/ofid/ofz360.904
- Erin Mays, Alan Kinlaw, Michael Swartwood, Asher Schranz, Renae Boerneke, Claire Farel, Ashley Marx. Evaluation of Adverse Drug Reactions due to Common Beta-Lactam Therapies Among Patients Enrolled in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program. Open Forum Infectious Diseases, Volume 6, Issue supplement 2, 23 October 2019, Page S332, https://doi.org/10.1093/ofid/ofz360.811
- Ashley Marx on behalf of the Vancomycin Treatment and Time to Adverse Drug Reactions During Outpatient Parenteral Antimicrobial Therapy (OPAT). Open Forum Infectious Diseases, Volume 5, Issue suppl_1, 26 November 2018, Pages S554.
- The Impact of a Positive Respiratory Viral Panel Among Hospitalized Adult Patients with Negative Rapid Influenza Testing at an Academic Tertiary Care Facility: A-matched Cohort Study. Open Forum Infectious Diseases, Volume 5, Issue suppl 1, 26 November 2018, Pages S268.
- Combating Carbapenem-Resistant Enterobacteriaceae: a presentation by Laurence Wright, PharmD, as a part of the Carolina Antimicrobial Stewardship Program Learning Series, September 2018
- Onyeka Nwankwo, Anh Eichholz, Vahini Chundi, Alan Kinlaw, Tenesha Medlin, Lisa Fletcher, Wesley Kufel, Claire Farel, Ashley Marx. Characterization of Readmissions Among Patients Enrolled in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program Over a 2-Year Period at UNC Medical Center. Open Forum Infectious Diseases, Volume 4, Issue suppl 1, 1 October 2017, Pages S335, https://doi.org/10.1093/ofid/ofx163.795
- Vahini Chundi, Anh Eichholz, Onyeka Nwankwo, Alan Kinlaw, Wesley Kufel, Tenesha Medlin, Lisa Fletcher, Ashley Marx, Claire Farel. Adverse Drug Reactions Among Patients Enrolled in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program 2015–2016 at UNC Medical Center. Open Forum Infectious Diseases, Volume 4, Issue suppl 1, 1 October 2017, Pages S341, https://doi.org/10.1093/ofid/ofx163.813
- Emily Ciccone, Vahini Chundi, Melissa Miller, Lauren DiBiase, David Weber, Jonathan Juliano, Ravi Jhaveri, Zachary Willis, on behalf of the UNC Antimicrobial Stewardship Team. The Impact of Respiratory Viral Testing in Hospitalized Adult Patients at a Tertiary Care Facility. Open Forum Infectious Diseases, Volume 4, Issue suppl 1, 1 October 2017, Pages S510, https://doi.org/10.1093/ofid/ofx163.1323
