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.

Montefiore/Einstein Stewardship Team

Priya Nori, MD, Program Director
 


Yi Guo, PharmD, Lead ID Pharmacist


KelsieKelsie Cowman, MPH, Stewardship Program Analyst


VijuViju Soma, MD; Director of ASP at CHAM


bartash Rachel Bartash, MD; ASP in Special Populations


Nidhi Saraiya, PharmD; ID/ASP Wakefield Campus

Philip Lee, PharmD; ID/ASP CHAM

Victor Chen, PharmD; ID/ASP Weiler Campus

Gregory Weston, MD; ASP/CCM-ID, IPC

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)

Publications/Abstracts

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. 

Guo Y, Chung P, Weiss C, Veltri K, Minamoto G.  Customized Order-Entry Sets Can Prevent Antiretroviral Prescribing Errors: A Novel Opportunity For Antimicrobial Stewardship. Pharmacy and Therapeutics. May 2015; 40 (5): 353-360 

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 

Online Modules

SHEA/CDC outbreak response Training Program  

Links

External Resources and Partners 

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; Supervisor, Microbiology Laboratory; Assistant Professor, Department of Pathology

Michael Levi, ScD, Director, Microbiology Laboratory; Associate Professor, Department of Pathology 

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


Quality and Safety 

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


Infection Prevention and Control 


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 

 

Conferences & Seminars

Change of location!! Infectious Diseases Grand Rounds @ Montefiore
Fellow's Presentation
Drs. Wadskier, Zielinski and Wexler
Wednesday, December 13, 2017 @ 8:30 AM

Conference & Seminar Schedules

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