Promoting safety in the use of antibiotics for Veterans

South Texas VA leading the way in antimicrobial stewardship


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After more than a decade of perseverance and dedication, the Antimicrobial Stewardship Program (ASP) at South Texas Veterans Health Care System in San Antonio has been designated by the Infectious Diseases Society of America as a Center of Excellence (CoE).

Since 2009, the program has been promoting safety and optimization in the use of antibiotics for care of our Veterans. With this designation, South Texas is in an elite group of designated institutions at the forefront of antimicrobial stewardship.

The antimicrobial stewardship team (AST) consists of a physician and clinical pharmacy specialists who monitor antibiotic use in the hospital. They use a computer program that searches for antibiotics currently being prescribed and that treat a wide array of bacteria.

From left are Dr. Elizabeth Walter, director of the Antimicrobial Stewardship Program, and Drs. Chelsea Sanchez and Linda Yang, clinical pharmacist specialists.

These types of antibiotics are of particular focus to the team. They can significantly affect many of the Veterans’ natural bacteria in the intestines and other sites. They also could cause the greatest impact on resistance to antibiotics in the many bacteria that they affect.

Team interacts with patient care team on antibiotic use

For Veterans who are on these broad-spectrum antibiotics, the team looks at the individual patient medical situations. That includes microbiology lab results and determining whether such a broad-spectrum antibiotic is necessary or if a more focused antibiotic could be used for that medical situation.

The team then interacts with the patient care team, advising them on optimal approaches to antibiotic use for the medical situation that minimizes exposure to these broad-spectrum antibiotics.

The AST follows prescribing data for both the hospital and the medical clinics to assess trends in antibiotic prescribing. The AST also educates health care practitioners on how to limit use of antibiotics with particular focus on limiting use of these broad-spectrum antibiotics.

A researcher in a microbiology lab examines a bacterial culture.

Another approach the AST undertakes to promote patient safety is to assesses data from the microbiology laboratory daily, which shows whether patients in the hospital or clinics have blood samples that have been drawn that are growing bacteria.

Some Veterans need to be treated expediently

Veterans with these results need to be treated expediently and appropriately, and the AST reviews all the patient medical records in these cases to make sure that antibiotics have been prescribed and are optimal for the type of bacteria present.

The AST may recommend an infectious diseases consult in cases they have reviewed that seem to be medically complex from an infection perspective.

Finally, when the Veteran must go home with antibiotic through the vein, the AST monitors the safety of this approach. It assesses labs weekly and makes changes to antibiotics or antibiotic dosing, as needed.

Leading the charge is Elizabeth Walter, M.D., ASP director for the last four years. Walter says she is honored to be recognized on such an esteemed level. But, she’s looking to the future, too, including networking with other medical centers through the Infectious Diseases Society of America.

“We’re proud to have this Center of Excellence designation for our Antimicrobial Stewardship Program. For years, we have been involved in interacting with the Center for Disease Control and collecting information on how antibiotics are used within our facilities.”

The field of antimicrobial stewardship is a new venture. Walter understands there is a need for a forum like the CoE to assist in developing smart goals. The networking capability of this forum will strengthen our program through shared information and innovation.

“It really shows our collective long-term dedication to patient safety. We’ve been willing to do research, be innovative, and strive to assist educating health care practitioners.

“There’s a lot of work to do. Networking among other CoE and pulling data together in a very meaningful way will further the evolution of the core competencies of antimicrobial stewardship.”


Justin Saucier is a public affairs specialist for the South Texas Veterans Health Care System.

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