Antimicrobial Stewardship Pearls to Optimize Patient Outcomes: Matthew B. Goetz, MD

“Clearly, stewardship is a team operation. It starts [with] the leadership, the clinical pharmacy, and coordination with infectious disease physicians truly has to be synergistic,” Goetz said in the keynote address at MAD-ID 2022.

The key to successful antimicrobial stewardship program involves a combination of factors, including proper staffing, adequate institutional support, a surplus of data, accurate diagnoses, and some behavioral modifications, according to Matthew B. Goetz, MD.

Goetz, chief of infectious diseases at VA Greater Los Angeles Healthcare System, shared these pearls in his keynote address, delivered at the Making a Difference in Infectious Disease (MAD-ID) 2022 annual meeting, held May 18-21, 2022, in Orlando, Florida.

The first step to success is a synergistic relationship between all stakeholders, including infectious disease (ID) physicians, ID pharmacists, microbiology, hospital administrators, infection control, hospital epidemiologists, and more.

“Clearly, stewardship is a team operation. It starts [with] the leadership, the clinical pharmacy, and coordination with infectious disease physicians truly has to be synergistic,” Goetz told Contagion in video interview. “There’re 2 types of stewardship interventions, as I look at it. The type of intervention that’s making sure that, for the diagnosis that is made, the right antibiotic is chosen, delivered for the right duration of time and by the right route. And then there’s the kind of stewardship that’s, ‘Is the proper diagnosis being made that the person has an infection?’”

A key driver of stewardship programs is to, ultimately, decrease the impact of antibiotic resistance, Goetz said, although monitoring resistance presents some challenges.

“Antibiotic resistance is a hard outcome to measure because it happens at a population level at long distances of time from when the actual interventions are made,” he said. “We know from meta-analyses that, after the implementation of stewardship programs, there’s a decrease in antibiotic resistance as seen across facilities. Some of these studies are a little but hindered by the retrospective nature of their analyses and the type of statistical analysis that was done.”

The patient-provider relationship can also play a role when it comes to antimicrobial prescribing habits. “Stage-setting,” messaging campaigns, and passive education can help arm providers with more tools heading into those sometimes tense conversations.

Goetz concluded by touching on the importance of accurate diagnosis, which is at the core of prescribing decisions.

“I think where the greatest future change can come into play is in diagnostic stewardship, assuring not only that we’re giving the right antibiotic for the right infection, but there truly is an infection there in the first place,” he said.