Antimicrobial Stewardship Program

Antibiotic resistance is a major issue affecting the entire healthcare spectrum and beyond. On average, approximately 60% of hospitalized patients receive an antibiotic, and national data shows significant need to improve prescribing practices.

The MLH Antimicrobial Stewardship Program (ASP) was created in 2017 to help improve antimicrobial use at our facility. Our mission is to promote the appropriate use of antimicrobials to maximize treatment outcomes and minimize unintended consequences of antimicrobial therapy. This website contains tools, guidelines, policies, and contact information to aid in antimicrobial clinical decision-making, thereby promoting patient safety at Mary Lanning.

Antibiograms 2025

• Gram-Negatives (Non-Urine)
• Gram-Positives (Non-Urine)
• Gram-Negatives (Urine)
• Gram-Positives (Urine)

Guidance Documents

• Skin/Soft Tissue Infection Antibiotic Selection
• Penicillin Allergy Assessment Algorithm
• Empiric Antibiotic Recommendations for Positive Blood Cultures
• Empiric Antibiotic Recommendations for Community-Acquired Pneumonia

Antimicrobials warranting mandatory ASP review
Antimicrobial Stewardship service will perform an antibiotic time-out at 48 hours, when available, to review appropriateness of the following antimicrobial(s).

• Carbapenems
• Daptomycin
• Piperacillin/tazobactam + vancomycin combination therapy

If the Antimicrobial Stewardship service and primary provider disagree on continued antimicrobial therapy for antimicrobials warranting mandatory ASP review, an ID consult will be placed by the ASP pharmacist using the order mode, "Per Protocol, Cosign Required." In this scenario, the antimicrobial(s) will continue until ID consultation is complete and treatment regimen is decided by the ID service.

This applies to inpatient orders not ordered by Infectious Disease or Critical Care services.

Indications for mandatory ID consults
The Infectious Disease service shall be consulted automatically for the following situations, when available:

1. Methicillin-sensitive Staphylococcus aureus (MSSA) or MRSA bacteremia
2. Fungemia
3. Suspected or confirmed carbapenem-resistant enterobacteriaceae (CRE)
4. Active tuberculosis or other highly contagious diseases of public risk (influenza excluded from automatic ID consult)
5. Febrile neutropenia (ANC < 500 cells per uL) with persistent fever (body temperature above 100.3) after 48 hours of admission
6. Severe or severe/complicated Clostridium difficile infection as defined by the Clostridium difficile management algorithm

The primary team or ASP pharmacist will enter the Infectious Disease consult if any of the criteria for automatic ID consult exists. A consult entered by the ASP pharmacist will be signed using the order mode, "Per Protocol, Cosign Required."

John Hopkins Antibiotic Guide (MLH Network Only)