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Purpose To provide an updated review of the diagnosis and pharmacotherapy of nontuberculous mycobacteria pulmonary disease (NTM-PD) and summarize guideline recommendations for an interdisciplinary treatment approach. Summary A systemic approach was taken in which all articles in English in MEDLINE and PubMed were reviewed. The US National Library of Medicine's DailyMed database was used to assess drug package inserts. Analysis of NTM treatment guidelines is summarized in the article with a focus on medications, dosing, interactions, and medication monitoring. Conclusion It is critical to manage patients with NTM with a multidisciplinary team approach. Treatment is prolonged and expensive, and the potential for drug toxicity, adverse effects, and drug interactions requires monitoring. Clinical pharmacists play a role in the management of NTM.

The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial stewardship (AMS) program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.

BackgroundRapid organism identification (ID) and antimicrobial susceptibility testing (AST) are critical to treatment of infected patients. We sought to capture time between specimens collected for bacterial culture and appropriate therapy for patients, along with other pertinent patient management data from 2017 (without MALDI-TOF/Vitek 2 and ASP) and 2018 (with MALDI-TOF/Vitek 2 and ASP).MethodsPatients were eligible if admitted to CHI Health in March or April 2018 either with positive sputum, blood, or urine culture. Patients were retrospectively obtained from the Microbiology Laboratory for March 2017 and sequential patients with positive culture were reviewed. A total of 75 patients from each year (25 positive blood cultures, 25 urine cultures, 25 sputum cultures),, respectively, were compared. A time-in-motion study was performed to compare time to identification (ID), AST results and acted upon by ASP. Data were entered into SPSS (ver. 25) for analysis. Results are reported as mean (±SD) or percentage.ResultsMean patient age and Charlson comorbidity index was not significantly different between 2017 and 2018. Time to obtain culture, delivery to Microbiology, and Gram-stain was not different between the two groups. Time to organism ID was significantly faster in 2018 (2018, 25.2 ± 13.7; 2017, 34.2 ± 17 hours, P = 0.001). Time to AST results was also significantly faster for patients in 2018 compared with 2017 (19.8 ± 14.1 compared with 28.5 ± 15.1 hours, P = 0.001). ASP recommended significantly more adjustments to empiric antimicrobial therapy (25% of 2018 vs. 1% in 2017, P < 0.001). In addition, length of hospital stay was significantly shorter for patients in 2018 compared with 2017 (2018, 8.3 ± 7 days; 2017, 15.6 ± 18.3 days, P < 0.001). Finally, in-hospital length of antimicrobial therapy was significantly shorter in 2018 compared with 2017 (2018, 6.6 ± 3.7 days; 2017, 8.8 ± 7.7 days, P < 0.05).ConclusionThe use of MALDI-TOF/Vitek 2 leads to an average 18 hours faster microbial ID and AST results. ASP is able to make recommendations for infectious diseases management more appropriately with quicker ID and AST results.Disclosures All authors: No reported disclosures.