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The Carolina Antimicrobial Stewardship Program (CASP) and the Outpatient Parenteral Antibiotic Therapy Program (OPAT) began in 2016 as joint programs of the UNC Medical Center Department of Pharmacy and the Divisions of Adult and Pediatric Infectious Diseases.

CASP supports the appropriate and effective use of antimicrobials

A multidisciplinary team provides guidance and tools to support clinical decision-making. CASP provides stewardship consults to assist UNC Medical Center colleagues with:


  • Empiric use of antimicrobials
  • Optimal duration of therapy
  • Diagnostic testing for infections
  • Approval of restricted antimicrobials
  • Alternative antibiotics in patients with allergies
  • De-escalation of antibiotics


Carolina Antimicrobial Stewardship Program’s 2023-24 Strategies

Each year, CASP implements strategies to optimize antimicrobial therapies for patients who need them. Core strategies are carried out every year as foundational to UNC Hospitals’ antimicrobial stewardship program; special focus strategies respond to opportunities for quality improvement based on hospital data and trends. Strategies are led by CASP’s core team of antimicrobial stewardship physicians and pharmacists.

Core Strategies
 Conduct prospective audit and feedback on antibiotic use to optimize patients’ antimicrobial therapy

Participate in the CDC National Healthcare Surveillance Network’s Antimicrobial Use & Resistance modules

Collaborate with the Stop Healthcare-associated Infections in Every Patient (SHINE) Initiative to reduce C. difficile and bloodstream infections

Carry out antimicrobial stewardship education and training for the next generation of stewards

Special Focus Strategies
Implement, expand, and monitor penicillin allergy assessments to improve the accuracy of allergy documentation

Expand outpatient stewardship infrastructure

Improve diagnosis and management of non-catheter-associated urinary tract infections among adults

Optimize ordering, dispensing, and delivery of perioperative antibiotics in the Children’s Hospital operating room to prevent surgical site infections

Create a pathway for diagnosis and treatment of sacral osteomyelitis

Design and implement a handshake stewardship pilot

Enhance the hospitals’ antibiogram in Tableau

Optimize use of the methicillin-resistant Staphylococcus aureus (MRSA) PCR test to reduce inappropriate use of anti-MRSA antibiotics

Evaluate treatment duration for Enterobacterales bloodstream infection due to pyelonephritis and C. difficile

Enhance blood culture stewardship at UNC Children’s Hospital

Update pediatric hematology/oncology antimicrobial prophylaxis guidelines

OPAT Objectives

  • Ensure accurate transitions of care for patients leaving UNC Hospitals on parenteral antibiotics
  • Provide monitoring and evaluation of clinical issues for patients enrolled in the program

Learn more about OPAT at the UNC Medical Center

 IV tubing and antibiotic infusion