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graph of OPAT conditions by yearThe 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.

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

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:

  • CDC Optimizing therapyEmpiric 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

Each year, CASP implements strategies to optimize antimicrobial therapies for patients who need them. Core strategies (1-4 below) are carried out every year as foundational to UNC Hospitals’ antimicrobial stewardship program; special focus strategies (5-15 below) 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.

Carolina Antimicrobial Stewardship Program’s 2023-24 Strategies


1. Conduct prospective audit and feedback on antibiotic use to optimize patients’ antimicrobial therapy
2. Participate in the CDC National Healthcare Surveillance Network’s Antimicrobial Use & Resistance modules
3. Collaborate with the Stop Healthcare-associated Infections in Every Patient (SHINE) Initiative to reduce C. difficile and bloodstream infections
4. Carry out antimicrobial stewardship education and training for the next generation of stewards


5.  Implement, expand, and monitor penicillin allergy assessments to improve the accuracy of allergy documentation
6.  Expand outpatient stewardship infrastructure
7.  Improve diagnosis and management of non-catheter-associated urinary tract infections among adults
8.  Optimize ordering, dispensing, and delivery of perioperative antibiotics in the Children’s Hospital operating room to prevent surgical site infections
9.  Create a pathway for diagnosis and treatment of sacral osteomyelitis
10.  Design and implement a handshake stewardship pilot
11.  Enhance the hospitals’ antibiogram in Tableau
12. Optimize use of the methicillin-resistant Staphylococcus aureus (MRSA) PCR test to reduce inappropriate use of anti-MRSA antibiotics
13. Evaluate treatment duration for Enterobacterales bloodstream infection due to pyelonephritis and C. difficile
14. Enhance blood culture stewardship at UNC Children’s Hospital
15. Update pediatric hematology/oncology antimicrobial prophylaxis guidelines