October 15, 2019

CIMAR’s Dr. Gabriela Andujar Vazquez traveled to Washington, D.C., last week to present findings from a pilot study she ran promoting antimicrobial stewardship (AS) best practices at 10 long-term care facilities. Dr. Andujar is an attending physician in the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center and Assistant Professor of Medicine at Tufts University School of Medicine. She is also part of Tufts Medical Center Antimicrobial Stewardship Team and was an awardee of the first ever Leadership in Epidemiology, Antimicrobial Stewardship, and Public health (LEAP) Fellowship program. This is a training award competitively granted to four promising young infectious diseases physicians and is funded by the Centers for Disease Control and Prevention.

The Tufts Medical Center AS team partners with the Massachusetts Department of Public Health (MDPH) to provide broad based support to long term care facilities (LTCFs) in their efforts to improve upon their AS and Infection Control practices. Over the years, these facilities consistently expressed their desire for individualized help and hands-on involvement by AS experts despite extremely limited access to these types of services.

Dr. Andujar’s LEAP project was a pilot study designed to test the feasibility and efficacy of providing enhanced support in AS and infection control to LTCFs. She enrolled 10 facilities that had been participating in the MDPH educational programs and submitting monthly antibiotic usage data as part of those programs. The study was a randomized control trial comparing enhanced antimicrobial stewardship with broad based education in LTFC in Massachusetts.  Aim 1 was to determine whether antibiotic usage would decrease over time in LTCFs receiving broad based education as part of the MDPH AS program.  Aim 2 was to determine whether enhanced guidance by a stewardship expert provided to a subset of LTCFs would lead to more substantial decreases in antibiotic usage. Dr. Andujar provided this enhanced guidance by  reviewing their protocols and toolkits,  performing weekly case reviews of residents started on antibiotics, providing feedback to prescribers, being available for questions from staff, giving lectures on antibiotic selection and duration, and meeting with electronic medical record (EMR) stakeholders to try to leverage the EMR for AS interventions.  Results of the study a statistically significant 20% decrease in antibiotic start rate in the enhanced group after interventions and no difference in antibiotic stars rate in the non-enhanced group, potentially demonstrating the benefit of enhanced antimicrobial stewardship support by an expert on antibiotic use in long term care.

At IDWeek in Washington DC in October, Dr. Andujar talked about many of the challenges in working with LTFCs and discussed strategies to overcome these barriers. She also pointed out the importance of the relationship with the Department of Public Health to help navigate the long term care structure and maintaining a connection with LTFCs. She highlighted the need for collaboration between DPH, clinicians and academia in order to tackle antimicrobial resistance.

Dr. Andujar’sLEAP project was mentored by Dr. David Snydman and Dr. Shira Doron, both members of CIMAR’s leadership and core faculty respectively, and Dr. Kira Beaulac, ID Pharmacist Head of Tufts Medical Center AS Team.