Antimicrobial Stewardship Program
Antimicrobial stewardship is defined as a rational, systematic approach to the use of antimicrobial agents to achieve optimal outcomes. This means using the right agent, at the correct dose, for the appropriate duration in order to cure or prevent infection, while minimizing toxicity and emergence of resistance.
“Antibiotic resistance can affect any person, at any stage of life . . . antibiotic resistance jeopardizes advancements in modern health care.”
- Centers for Disease Control and Prevention, Antibiotic Resistance Threats in the United States, 2019
Through a joint effort of Nebraska Medicine’s Pharmacy, and Infection Control and Epidemiology Departments, and the University of Nebraska Medical Centers Division of Infectious Diseases, the Antimicrobial Stewardship Program (ASP) at Nebraska Medicine has been active since August 2004. The mission of the ASP is to optimize the utilization of antimicrobial agents to realize improved patient outcomes, a positive effect on antimicrobial resistance, and an economic benefit.
The ASP at NM has grown over the years and now provides support to both our main campus as well as the Bellevue Medical Center. It has developed a dedicated Outpatient Parenteral Antimicrobial Therapy (OPAT) program as well as a remote stewardship program which supports similar efforts at other facilities.
Read about current events and subscribe to our UNMC Infectious Diseases blog.
The NM ASP is also associated with the State of Nebraska’s Antimicrobial Stewardship Assessment and Promotion (ASAP) program which provides resources for small/critical-access hospitals and long-term care facilities. Information about ASAP can be found at our companion site: asap.nebraskamed.com
ASP Links
The latest news from the Antimicrobial Stewardship Program
If you are encounter a broken link or have trouble locating Antimicrobial Stewardship Program guidance documents, please email Dr. Jonathan Ryder.
- May 2025
- March 2025
- November 2024
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Happy Antibiotic Awareness Week! Follow our blog for more details.
- Common Durations of Antibiotic Therapy: Shorter is Better
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Sara Azimi is the new lead pharmacist for our Remote Antimicrobial Stewardship Support Program.
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- October 2024
- July 2024
- June 2024
- May 2024
- April 2024
- March 2024
- December 2023
- November 2023
- October 2023
- September 2023
- June 2023
- May 2023
- March 2023
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Penicillin Allergy Guidance and Graded Challenge Order Set Updated
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Guidance on When to Draw Blood Cultures Established: Blood Culture Utilization Guidance, Initial Blood Cultures Algorithm and Follow-Up Blood Cultures Algorithm
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COVID-19 Treatment Guidance Updated: COVID-19 Antiviral and Pharmacotherapy Information, Outpatient COVID Therapies Update and Outpatient COVID-19 Treatment Algorithm
- Antiretroviral formulations and ability to manipulate/crush
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- January 2023
Past ASP News
2022
- December 2022
- November 2022
- October 2022
- August 2022
- July 2022
- May 2022
- April 2022
- New antibiograms available
- SBAR for PCN allergy changes:
- Surgical prophylaxis: Cefazolin is now considered safe to administer to patients with penicillin allergies, with the risk of reaction being similar to patients without an allergy. Therefore the wording of order sets has been changed to recommend alternatives only in patients with severe cephalosporin allergies, rather than severe beta-lactam allergies. This should improve patient care since cephalosporins have been proven to be most effective agents at preventing surgical site infections compared to the alternatives of vancomycin and clindamycin. More information here and here.
- Epic changes: Starting with the update to Epic coming next week, minor allergies and unknown reactions to penicillin will no longer trigger a drug interaction/safety warning when cephalosporins are ordered. Severe reactions to penicillin will continue to be flagged for prescriber awareness. While we consider cefazolin safe to administer in any patients due to its different chemical structure, this change in alerting impacts the entire class of cephalosporins. ASP has developed a table indicating when cross-reactions are most likely, with cephalexin being the most common agent to cause an adverse reaction in patients with penicillin allergy.
- February 2022
- January 2022
2021
- November 2021
- Atovaquone-proguanil added to formulary
- August 2021
- Expanded Rapid Blood Culture ID Panel Implemented with new Guidance
- Updated Guideline on Management of Positive Blood Culture with Negative BCID Result
- Ceftazidime/avibactam added to formulary
- Artesunate and Coartem added to formulary for malaria - Contact ASP
- Antibiotics for Sepsis Updated
- Summer 2021
- Spring 2021
2020
- Fall 2020
- Summer 2020
- Spring 2020
- COVID-19 management resources
- Pneumonia Panel Implementation
- Guidance on Rapid Blood Culture Results “Not Detected”
- New Antibiograms including Urinary Isolates
- Antimicrobial Spectrum Teaching Chart
2019
- Fall/Winter 2019
- Dosing Protocols updated including new guidance for Ceftolozane/tazobactam, Colistin, and Polymyxin B
- OPAT page updated with indications and guidance for MAT
- Microbiology nudge implemented
- Summer 2019
- Sepsis antibiotic recommendations updated
- C. difficile – Healthcare Professional’s Role in Preventing C.diff, Nursing Guidance on Testing (Stool Assessment Tool) and Support Staff’s Role in Preventing C.diff
- Antibiograms distributed – Gram negative Combination therapy, 2018 Inpatient (color), Tri-fold Pocket Card, and Bellevue Overall
- New team members joined
- OPAT program started
- Biocontainment Resources added
- Spring 2019
- Educational Opportunities added – PGY2 Pharmacy Residency, ID Medical Fellowship, Antimicrobial Stewardship Summit, UNMC ID blog and Twitter feed.
- C. difficile - Testing algorithm and Antibiotic Risk/Cost
- Dalbavancin added to formulary
2018
- Fall 2018
- Clostridium difficile infection testing algorithm
- Oral Sulfa desensitization
- Renal Dose Adjustments Updated
- Spring 2018
- Alternatives to Using Piperacillin/Tazobactam with Vancomycin
- Clostridium difficile Guidance modified
- New Guidance on Skin and Soft Tissue Infections
- Outpatient Antimicrobial Stewardship Primer
- Renal Dose Adjustments Updated
- Surgical Prophylaxis Guidance Updated
- Winter 2018
- Penicillin Allergy Guidance Document
- Peritoneal Dialysis Antimicrobial Dosing Recommendations
2017
- Fall 2017
- Bezlotoxumab Added to Formulary
- C. difficile Treatment Guidelines Updated
- Diabetic Foot Infection Treatment Guideline Created
- Summer 2017
- Rapid Blood Culture ID Panel Guidance Updated
- Miltefosine Added to Formulary
- Isavuconazole Added to Formulary
- February 2017
- GI Pathogen Panel Restriction and Guidance Updated
- Guideline on Antibiotic Use in Acute Exacerbations of COPD Published
2016
- November 2016
- Renal Dose Adjustment Guidance for Antimicrobial CRRT Dosing Published
- Guidance on Interpretation of Meningitis/Encephalitis Panel Published
- Cefepime Dosing Protocol Updated
- Antibiotic Prophylaxis for Open Fractures Updated
- New and Updated Guidelines, March 2016
- Surgical prophylaxis recommendations updated for ENT and Cardiac procedures
- Intra-operative Redosing Reminders Introduced
- Renal dosing protocol updated
- Adult Pneumococcal Vaccine Recommendations published
2015
- November 2015
- Dose Rounding Policy for Antimicrobials Implemented
- Changes to oral ribavirin treatment guidance including lung transplants
- Guidelines for antibiotic use in open fractures published
- New cephalosporin agents reviewed and ceftolozane/tazobactam added to the formulary
- Pneumonia Guidelines, July 2015
- Community-Acquired Pneumonia
- Pneumonia: Healthcare-associated, hospital-acquired, and ventilator-associated
- March 2015
- Peramivir added to the formulary, March 2015
- Changes to Urine and Blood Culture Orders (restricted)
2014
- New Guidelines Published, December 2014
- Stool Pathogen Panel Introduced
- New Institutional Antimicrobial Surgical Prophylaxis Guideline Published
- Antimicrobial Stewardship Guidance now available as app
- Microbiology laboratory changes, July 2014
- Changes in gram-negative pathogen susceptibility reporting
- Rapid Blood Culture ID Panel Common Misinterpretations
- TNMC urinary antibiogram developed
- New Clinical Guidelines Published, August 2014
- Institutional Guidelines for the Treatment of Staphylococcus aureus Bloodstream Infection
- Institutional Guidelines for the Evaluation and Treatment of Urinary Tract Infections and Asymptomatic Bacteriuria
- Formulary changes, June 2014
- Levofloxacin Added to Formulary, February 2014
- Multiple institutional treatment guidelines updated, February 2014
- Community-acquired pneumonia
- Healthcare-associated, Hospital-acquired, and Ventilator-associated Pneumonia
- Institutional guidelines for treatment of skin and soft tissue infections
2013
- Rapid Blood Culture Pathogen Identification System Introduced and Antimicrobial Stewardship Recommendations for Interpretation, November 2013
- C. difficile Treatment Pathway Updated, November 2013
- Continuous Venovenous Hemofiltration Anti-infective Dosing Added to Renal Dosing Document, April, 2013
2012
- Top 10 Tips from Antimicrobial Stewardship and Infection Control, December 2012
- Creating a Robust Antimicrobial Stewardship Program, July 2012
- Combination Gram-negative Antibiogram Developed, July 2012
- Fungal Antibiogram Developed, July 2012
- Aminoglycoside Dosing Protocol for Patients with Cystic Fibrosis, July 2012
- Added/expanded anti-infective restrictions for colistin, cytomegalovirus immune globulin and tigecycline, March 2012
- Comprehensive update to antimicrobial renal dosing document, March 2012
- Addition of Procalcitoinin and Publication of Institutional Guidance, February 2012
2011
- New Dosing Protocol for Cefepime and Piperacillin/tazobactam Implemented, November 2011
- Piperacillin/tazobactam Dosing Protocol
- Cefepime Dosing Protocol, Updated April 2018
- Fosfomycin Added to Inpatient Formulary, April 2011
- Multiple Institutional Guidelines Updated, April 2011
- Institutional Guidelines for the Treatment of Invasive Candidiasis
- Community-Acquired Pneumonia
- Sepsis Empiric Antibiotic Recommendations
- Guidelines for Treatment of Skin and Soft Tissue Infections
- Guidelines for the Prevention of Perinatal Group B Streptococcal Disease, April 2011
2010
- Pneumococcal and Legionella Urinary Antigen Tests Available at TNMC
- FDA Reports Increased Mortality with Tigecycline, September 2010
- Addition of a Reflex Test for Clostridium difficile, September 2010
- Antimicrobial and Clinical Microbiology Guidebook updated and republished, Original July 2010, Updated May 2012
- Information regarding redundant anaerobic coverage now available, July 2010
- Institutional Guidelines for the Treatment of Invasive Candidiasis Implemented, February 2010
- Meropenem Dosing and Therapeutic Interchange Policy Implemented, February 2010
- Clostridium difficile Infection Pathway Updated, February 2010
- Meropenem and Ertapenem Added to the Formulary, Imipenem Removed, January 2010
2009
- Information for Interpretation of Viral Diagnostic Tests Now Available, October 2009
- Institutional Guidance for the 2009-2010 Influenza Season available, updated September 2009
- Ethanol Lock Technique Approved and Implemented, September 2009
- Updated Rabies Vaccination Schedule, August 2009
- New Clostridium difficile assay implemented, July 2009
- Pneumonia Pathways and Order Form updated, June 2009
- Influenza Treatment and Prophylaxis Guidelines for The Nebraska Medical Center, March 2009
- Pharmacokinetic Training Packet Updated, January 2009
2008
- TheraDoc Implemented for Antimicrobial Stewardship Program, October 2008
- Antibiotic Desensitization Protocols Implemented, May 2008
2007
- New procedures for management of C. difficile-associated disease implemented, July 2007
- Guidelines for treatment of skin and soft tissue infections implemented, June 2007
- FDA Warning - Linezolid (Zyvox), March 2007
- Micafungin replaces caspofungin on Inpatient Formulary, February 2007
- Benefits of Antimicrobial Surgical Prophylaxis Order Form, February 2007
- Zostavax added to Outpatient Formulary, January 2007
2006
- Renal Dosage Adjustment Guidelines for Antimicrobials Implemented, June 2006
Additional information here - Pneumonia Pathways and Order Form Implemented, May 2006
- Tigecycline added to Inpatient Formulary, March 2006
2005
- Therapeutic Interchange for Penicillins and Cephalosporins Implemented (Restricted), November 2005