Division of Infectious Diseases

Antibiotic/Antimicrobial Stewardship Program

 

Our Mission 

  • To promote responsible and rational antimicrobial use by providers and patients alike
  • To increase public health awareness about the threat of antimicrobial resistance
  • To educate and empower clinical champions of antimicrobial stewardship 
  • To mentor stewardship leaders of tomorrow

What We Do 

As much as 50 percent of all antibiotic prescriptions are considered “inappropriate.” Experts consider antibiotics to be “inappropriate” when they are prescribed for non-bacterial infections, the spectrum of coverage is overly broad and potentially toxic, the dose is inaccurate for the host, or the intended duration is too long. “Inappropriateness” contributes directly to medication side effects, interactions, kidney and liver dysfunction, Clostridium difficile infections (CDI), and the emergence of multi-drug resistant pathogens. As early as 1945, Sir Alexander Fleming, the pioneer of the antibiotic era, warned that the overuse of antibiotics “clearly drives the evolution of resistance.”

In 2014 President Obama introduced multi-drug resistance as a national security issue and recognized antimicrobial stewardship as the first line of defense. In 2016, the Centers for Medicare and Medicaid Services and the Joint Commission joined the narrative by emphasizing the need for stewardship across the healthcare continuum (inpatient and ambulatory sites). Mainstream recognition of the scope of antibiotic resistance allows us to implement meaningful solutions. CDC’s “Core Elements of Hospital Antibiotic Stewardship Programs” provide a framework for successful ASP development. These include:

  • Leadership commitment
  • Accountability 
  • Drug Expertise
  • Action
  • Tracking
  • Reporting 
  • Education

In July 2008, Montefiore Medical Center initiated a multifaceted interdisciplinary stewardship program to educate, support, and advise practicing physicians throughout its extensive Bronx network of hospitals, ambulatory care clinics, and nursing homes. Stewardship operations occur at each of our academic campuses (Moses, Einstein, and Wakefield) and the Children's Hospital at Montefiore (CHAM). Our strategic stewardship plan is adapted from the Infectious Diseases Society of America (IDSA) guidelines and upholds the CDC’s core stewardship elements to the highest degree. Together with institutional liaisons and stewardship champions, we provide aggregate data on antimicrobial resistance and microbiology, and promote antimicrobial prescribing best practices. Montefiore/Einstein Stewardship members have published in the areas of rapid diagnostic technology and stewardship, quality improvement initiatives to improve community acquired pneumonia management, stewardship and Clostridium difficile infection, stewardship and HIV, stewardship in outpatient parenteral antibiotic therapy, carbapenem-resistant Klebsiella and other enterobacteriaceae, medical education in stewardship and infection prevention, and stewardship in special populations.

ASP role in Montefiore/Einstein's COVID-19 Pandemic Response  

 The Montefiore/Einstein Antimicrobial Stewardship Program has served as a fundamental pillar of the health system's COVID19 pandemic response. Key stewardship pandemic response functions include:
  • Experimental treatments guideline development 
  • Expanded access protocol development
  • Diagnostic stewardship of SARS-CoV-2 PCR and serology
  • Clinical trial assistance (remdesivir, convalescent plasma)
  • Development of empiric antibiotic protocols
  • Data analytics, surveillance, and reporting for crucial COVID-19 metrics

Access ASP/ID experimental treatment protocol here 

Access ASP COVID-19 empiric antibiotic guidelines here 

 
 Featured publications and news articles related to ASPs and the COVID19 pandemic     

 

 

Montefiore/Einstein Stewardship Team

Priya Nori, MD, Medical Director of ASP and OPAT
 


Belinda Ostrowsky, MD, Founding Member
 


Yi Guo, PharmD, Pharmacy Director of Antimicrobial Stewardship Program


KelsieKelsie Cowman, MPH, Stewardship Program Analyst


bartash Rachel Bartash, MD; ASP in Special Populations


 Victor IDVictor Chen, PharmD; ID/ASP Weiler Campus


 Philip IDPhilip J. Lee, PharmD; ID/ASP CHAM Campus


 Gregory ID Gregory D. Weston, PharmD; ID/ASP CCM-ID, IPC 


 Chitra ID Chitra Punjabi, MD; ID/ASP Weiler Campus 

 

  

Toolkits, Publications, Abstracts, and Online Modules

Toolkits

Big Bugs, Few Drugs: Infectious Disease and Antimicrobial Stewardship  

AHRQ toolkit helps hospitals improve antibiotic selection to reduce deadly C. difficile infections (AHRQ)

Antimicrobial Stewardship Toolkit: Best Practices from the GNYHA/UHF Antimicrobial Stewardship Collective 

Publications/Abstracts

 

Using Technology to Enhance Antimicrobial Stewardship Impact in the Acute Care SettingCurrent Treatment Options in Infectious Diseases 

Multidisciplinary Tool Kit for Febrile Neutropenia: Stewardship Guidelines, Staphylococcus aureus Epidemiology, and Antibiotic Use RatiosJournal of Oncology Practice 

Diagnostic stewardship of Clostridioides difficile polymerase chain reaction results from syndromic diarrhea panel and implications for patient outcomesDiagnostic Microbiology and Infectious Disease   

Creative Collaborations in Antimicrobial Stewardship: Using the CDC’s Core Elements as Your GuideMedical Clinics of North America  

 Faces of Resistance: Using Real-World Patients and Their Advocates to Teach Medical Students About Antimicrobial StewardshipOpen Forum Infectious Diseases 

Bundle in the Bronx: Impact of a Transition-of-Care Outpatient Parenteral Antibiotic Therapy Bundle on All-Cause 30-Day Hospital Readmissions   

Antimicrobial Stewardship and Automated Pharmacy Technology Improve Antibiotic Appropriateness for Community-Acquired Pneumonia (ICHE)

Developing Interactive Antimicrobial Stewardship and Infection Prevention Curricula for Diverse Learners: A Tailored Approach. 

Customized Order-Entry Sets Can Prevent Antiretroviral Prescribing Errors: A Novel Opportunity For Antimicrobial Stewardship. 

Beta-lactam combination therapy for the treatment of Staphylococcus aureus and Enterococcus species bacteremia: A summary and appraisal of the evidence. 

Ceftazidime–avibactam Susceptibility Patterns in Carbapenem-Resistant Enterobacteriaceae in the USA: Results from the Consortium on Resistance against Carbapenems in Klebsiella and Other Enterobacteriaceae (CRACKLE-2) 

How to adapt the CDC's Core Elements of Antimicrobial Stewardship to your patients, pathogens, prescribers and personnel – Healio article

Working Together to Define Antibiotic Appropriateness: Point Prevalence Survey in 47 Intensive Care Units from 12 US Hospitals, Partnership for Quality Care, March 2017 

Hospital Emergency Response to Novel Influenza a (H1N1) Pandemic in a Large New York City Hospital: An Opportunity for Antimicrobial Stewardship 

Antimicrobial Stewardship Training for Infectious Diseases Fellows: Program Directors Identify a Curriculum NeedClinical Infectious Diseases 

Infectious Diseases Physicians: Leading the Way in Antimicrobial StewardshipClinical Infectious Diseases 

Online Modules

SHEA/CDC outbreak response Training Program  

External Resources and Partners 

Sanford Guide: 
 Montefiore/Einstein has partnered with the Sanford Guide on an ID and antimicrobial web resource and smartphone app. This is free for all Montefiore.org or Einstein.edu users. Featured content includes hospital and ICU antibiograms, empiric antibiotic guidelines, renal dosing guidelines, malaria protocols, Infection Prevention isolation guidelines, and much more. 
 
Go to https://webedition.sanfordguide.com/en on your work desktop. You can then register for the smartphone app from here

Our Partners and Champions

ID Division:
 Liise-anne Pirofski, MD, Chief, Division of Infectious Diseases; Professor, Departments of Medicine (ID) and Microbiology & Immunology
Essay: Life as an Infectious Diseases Physician Scientist: Science is Humanity’s Lifeline
Publications (PubMed)
Video: Einstein On: Antibotic ResistanceAntibiotic Stewardship: Changing the Culture 


Microbiology Laboratory: A Faster Approach to Identifying Bacteria 

 


Wendy A. Szymczak, PhD; Interim Director, Microbiology Laboratory; Assistant Professor, Department of Pathology


Philip Gialanella, B.S., M.S., Microbiology Laboratory Manager; Associate, Department of Pathology


Infection Prevention and Control  


Theresa Madaline, MD,Assistant Professor, Department of Medicine (Infectious Diseases)


Gregory Weston, MD, Infection Control, Moses Campus


Sun Park, MD, Infection Control, Weiler Campus


Infectious Diseases Fellowship Program 

Distinctions

Belinda Ostrowsky, MD - 2016 Montefiore President's Award 


Priya Nori, MD - Rising Star 


Yi Guo, PharmD, President of New York City Society of Health-system Pharmacists 

 
 

ASP News

Antimicrobial Stewardship Program Designated as Center of Excellence by IDSA
The Antimicrobial Stewardship Program (ASP) at Montefiore, led by medical director Priya Nori, MD, has been designated as a Center for Excellence by The Infectious Diseases Society of America (IDSA). It is among 25 academic sites in the nation – and one of few in New York City, to receive this prestigious recognition, which was announced on August 15, 2018.

 

 COE logo 

 
 
 

Conferences & Seminars

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