IV Fluid Shortage Mitigation Actions

As part of the IV fluids conservation efforts during this critical shortage, members of the DUHS Antimicrobial Stewardship and Evaluation team have proposed several mitigation strategies for IV antimicrobials. IV vancomycin is a high-volume item typically dispensed in larger fluid volumes (e.g., 250 mL NS), so alternatives to IV vancomycin according to indication and temporary changes to restrictions on linezolid and daptomycin are outlined.

Questions? Call 919-485-1736 or page 919-970-3521 to chat with an Infectious Diseases Pharmacist

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SHORTAGE ALERT! BD BACTEC Bottles -- July 2024

DUHS leaders expect our system to be affected by the BD BACTEC Blood culture bottle global shortage in late July 2024. Careful decisions about when to use Blood Cultures is now more important than ever. Review Adult Guidance and Pediatric Guidance on CustomID and linked in Maestro order panels. See Educational Content for teams implementing Blood Culture Stewardship in their areas.

Confused by that resistance pattern and when you can use piperacillin-tazobactam?

See the memo link from the DUHS Clinical Microbiology Laboratory with updates to current reporting for E. coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis. 

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DUHS COVID-19 Tracking Dashboard

Visit the DUHS COVID-19 Dashboard to stay informed on COVID-19 metrics including current inpatient census, positive testing rate, and overall DUHS COVID-19 trends. 

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Treatment Guidance for the Emergency Department

The Duke Antimicrobial Stewardship & Evaluation Team has collected several frequently used clinical references on a single page to serve as a helpful resource. 

Have further questions?? Call 919-485-1736 or page 919-970-3521 to chat with an Infectious Diseases Pharmacist! 

 

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BCID2 UPDATE - JULY 2024: Duke Clinical Microbiology Lab Announcement

Beginning July 9, 2024, the micro lab will report additional genotypic markers of antimicrobial resistance in Gram negative rods from the Blood Culture Identification (BCID) molecular panel. Check out the Adult Rapid Diagnostics at DUH Raleigh Campus (BCID2, Biofire) for treatment pathway recommendations. 

Additionally, the results for each of the 42 organism and resistance targets on the BCID panel will now be automatically reported. Thus, these results will look DIFFERENT!

Questions? Call 919-485-1736 or page 919-970-3521 to chat with Raleigh's Infectious Diseases Pharmacist! 

 

Is Your Patient Penicillin Allergic?

Did you know that a patient with a reported pencillin allergy has been correlated to higher costs, increased risk of antibiotic resistance, and worse patient outcomes? 

Take Action! Careful evaluation of antimicrobial allergy and prior tolerance history is essential to providing optimal treatment - follow the link to learn more!

Have further questions?? Call 919-485-1736 or page 919-970-3521 to chat with an Infectious Diseases Pharmacist! 

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Improve antibiotic prescribing by incorporating these four moments:

    1. Does this patient have an infection that requires antibiotics?  
    2. Have I ordered appropriate cultures before starting antibiotics?
    3. A day or more has passed. Can I stop antibiotics? Can I narrow therapy? Can I change from IV to PO?
    4. What duration of antibiotic therapy is needed for this patient's diagnosis? 

 

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Shorter is Better!

What is the BEST duration to effectively treat and minimize unintended consequences of antibiotics?? 

View our Targeted Antibiotic Duration document. We consolidated hundreds of pages of guidelines into 2 pages for easy reference! 

Have further questions?? Call 919-485-1736 or page 919-970-5321 to chat with an Infectious Diseases Pharmacist! 

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Uncomplicated Gram-negative Bacteremia Guideline

E. coli is the most common bloodstream pathogen at DUH Raleigh Campus.

Check out our Treatment Guideline here which includes antibiotic selection, optimal duration of therapy, when to use oral therapy, and need for repeat blood cultures.  ​

Have further questions?? Call 919-485-1736 or page 919-970-3521 to chat with an Infectious Diseases Pharmacist! 

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