Gabriela Andujar Vazquez, MD

• Attending physician, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center
• Assistant Professor of Medicine, Tufts University School of Medicine
• Inaugural LEAP Fellow for 2018-2019

Dr. Gabriela Andujar Vazquez is among the first awardees of the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) Fellowship. This competitive training award is granted to four promising young infectious diseases physicians annually and is funded by the Centers for Disease Control and Prevention. The fellowship aims to foster the next generation of infectious diseases leaders in public health, hospital epidemiology, and antimicrobial stewardship, giving them the hands-on experience they need to lead and collaborate across these disciplines in healthcare.

Dr. Andujar is part of the Antimicrobial Stewardship Team at Tufts Medical Center along with CIMAR Core Faculty member and the team’s lead physician, Dr. Shira Doron, as well as the team’s lead pharmacist, Dr. Kirthana Beaulac. She is especially interested in antimicrobial stewardship in long-term care settings, antimicrobial resistance, and hospital-acquired infections. The Tufts Medical Center Antimicrobial Stewardship team partners with the Massachusetts Department of Public Health (MADPH) to support long-term care facilities (LTCFs) in their efforts to improve upon their stewardship and infection control practices.

It is known that LTCFs can facilitate the spread of multi-drug resistant organisms and Clostridium difficile due to immunosenescence (the gradual deterioration of the immune system brought on by age), overuse of antibiotics, and communal living quarters, among other factors. Furthermore, these facilities tend to be resource-constrained, and lack the necessary expertise to apply essential antimicrobial stewardship and infection control measures, which are now federally mandated.

In partnership with the MADPH, the Tufts Medical Center Antimicrobial Stewardship team offers a comprehensive stewardship education program for LTCFs. Feedback from participating facilities repeatedly expresses that more individualized help is needed, although resources to obtain such support are scarce. Dr. Andujar’s LEAP project is designed as a pilot study and has enrolled nine facilities that now participate in educational webinars and submitting antibiotic usage data. The study has three aims: 1) to determine whether antibiotic usage decreases in LTCFs participating in the MADPH antimicrobial stewardship educational program, 2) to determine whether enhanced, facility-specific and patient-specific guidance by a stewardship expert provided to a subset of LTCFs leads to more substantial decreases in antibiotic usage as compared with LTCFs participating solely in the educational program, and 3) to determine whether LTCFs with lower antibiotic usage experience lower rates of Clostridium difficile infection.

Drug expertise is one of the CDC’s “Core Elements of Antimicrobial Stewardship” for nursing homes. Nursing homes are advised to “partner with antimicrobial stewardship leads from hospitals within their referral network” and to “develop relationships with infectious disease consultants interested in supporting their facility’s stewardship efforts.” Few Massachusetts LTCFs have managed to do this. Dr. Andujar’s LEAP project goal is to demonstrate the impact of facility-specific and patient-specific guidance by an expert on antibiotic usage. While comprehensive educational programs can be effective to a point, Dr. Andujar and colleagues expect that expert advice that is tailored to a facility and based on usage reports, case reviews, and real-time discussions will have a much greater impact on total antibiotic usage. Demonstrating this will provide the evidence facilities need to justify allocating resources to expert consultants (physicians or pharmacists with infectious disease training). Dr. Andujar hopes that the overall results from this project will be shared with the healthcare community as a proof of concept to encourage resource limited facilities to seek partnerships with antimicrobial stewardship experts. Tufts Medical Center’s Antimicrobial Stewardship team will continue to work with Massachusetts Department of Public Health officials to develop a model that would allow such partnerships to exist on a larger scale.

You can learn more about Dr. Andujar on her Tufts Medical Center profile page.