Antimicrobial Stewardship Guidelines: Syndrome-Specific Strategies

Opinion statement

Syndrome-specific interventions refer to systematic actions that are designed and implemented to improve treatment of specific infectious disease diagnoses such as pneumonia or urinary tract infection. The rationale behind implementation of syndrome-specific interventions is that antimicrobial stewardship programs (ASP) can apply their limited resources to focus on conditions where antimicrobial misuse is common, and utilize their expertise to develop interventions which can be operationalized by prescribers and other healthcare personnel, thus expanding ASP impact. Design and implementation of syndrome-specific interventions can be framed within the Centers for Disease Control and Prevention (CDC) core elements for ASPs: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Common intervention delivery mechanisms include electronic health record-based (EHR) decision support (e.g., syndrome-specific decision point algorithms and order sets), protocols that direct non-ASP personnel to screen and intervene to improve antibiotic use in uncomplicated conditions (e.g., pneumonia duration of therapy), and provider behavior-directed interventions such as antimicrobial “time-out” and individualized “audit and feedback.” Key considerations for implementation and sustainability include the following: aligning interventions with administrative priorities, designing the intervention to fit into existing workflow processes, utilizing local data to justify need and to evaluate intervention success, and periodic reassessment of the intervention to ensure fidelity, efficacy, and relevance. Examples of successful syndrome-specific interventions are reported; however, further evidence is needed, particularly regarding sustainability and scalability.

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