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.
ASP role in Montefiore/Einstein's COVID-19 Pandemic Response
The Montefiore/Einstein Antimicrobial Stewardship Program has served as a fundamental pillar of the health system's COVID19 pandemic response. Key stewardship pandemic response functions include:
- Experimental treatments guideline development
- Expanded access protocol development
- Diagnostic stewardship of SARS-CoV-2 PCR and serology
- Clinical trial assistance (remdesivir, convalescent plasma)
- Development of empiric antibiotic protocols
- Data analytics, surveillance, and reporting for crucial COVID-19 metrics
Access NIH COVID-19 treatment protocol here
Access ASP COVID-19 empiric antibiotic guidelines here
Featured publications and news articles related to ASPs and the COVID19 pandemic
Montefiore/Einstein
Stewardship Team
Priya Nori, MD, Medical Director of ASP and OPAT
Belinda Ostrowsky, MD, Founding Member
Yi Guo, PharmD, Pharmacy Director of Antimicrobial Stewardship Program
Kelsie Cowman, MPH, Stewardship Program Analyst
Rachel Bartash, MD; ASP in Special Populations
Victor Chen, PharmD; ID/ASP Weiler Campus
Philip J. Lee, PharmD; ID/ASP CHAM Campus
Gregory D. Weston, PharmD; ID/ASP CCM-ID, IPC
Chitra Punjabi, MD; ID/ASP Weiler Campus
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)
Antimicrobial
Stewardship Toolkit: Best Practices from the GNYHA/UHF Antimicrobial
Stewardship Collective
Publications/Abstracts
Using Technology to Enhance Antimicrobial Stewardship Impact in the Acute Care Setting, Current Treatment Options in Infectious Diseases
Multidisciplinary Tool Kit for Febrile Neutropenia: Stewardship Guidelines, Staphylococcus aureus Epidemiology, and Antibiotic Use Ratios, Journal of Oncology Practice
Diagnostic stewardship of Clostridioides difficile polymerase chain reaction results from syndromic diarrhea panel and implications for patient outcomes, Diagnostic Microbiology and Infectious Disease
Creative Collaborations in Antimicrobial Stewardship: Using the CDC’s Core Elements as Your Guide, Medical Clinics of North America
Faces of Resistance: Using Real-World Patients and Their Advocates to Teach Medical Students About Antimicrobial Stewardship, Open Forum Infectious Diseases
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.
Customized Order-Entry Sets Can Prevent Antiretroviral
Prescribing Errors: A Novel Opportunity For Antimicrobial Stewardship.
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
Antimicrobial Stewardship Training for Infectious Diseases Fellows: Program Directors Identify a Curriculum Need, Clinical Infectious Diseases
Infectious Diseases Physicians: Leading the Way in Antimicrobial Stewardship, Clinical Infectious Diseases
Online Modules
SHEA/CDC outbreak response Training Program
External Resources and Partners
Sanford Guide:
Montefiore/Einstein has partnered with the Sanford Guide on an ID and antimicrobial web resource and smartphone app. This is free for all Montefiore.org or Einstein.edu users. Featured content includes hospital and ICU antibiograms, empiric antibiotic guidelines, renal dosing guidelines, malaria protocols, Infection Prevention isolation guidelines, and much more.
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 Resistance; Antibiotic Stewardship: Changing the Culture
Microbiology Laboratory: A Faster Approach to Identifying Bacteria
Wendy A. Szymczak, PhD; Interim Director, Microbiology Laboratory; Assistant Professor, Department of Pathology
Philip Gialanella, B.S., M.S., Microbiology Laboratory Manager; Associate, Department of Pathology
Infection Prevention and Control
Theresa Madaline, MD,Assistant Professor, Department of Medicine (Infectious Diseases)
Gregory Weston, MD, Infection Control, Moses Campus
Sun Park, MD, Infection Control, Weiler Campus
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