The overuse of antibiotics is a large problem in healthcare today, accelerating the development of microbial resistance to antibiotics. Antibiotic stewardship campaigns have been implemented to help clinicians curb their use. Procalcitonin is a serum peptide and marker of inflammation secreted in response to microbial toxins. For this reason it is more specific to bacterial infections than other markers of general inflammation , like Creactive protein. The population of patients with sepsis in the Intensive Care Unit is one in which extended durations of antibiotics are used. The FDA has approved use of procalcitonin to guide de-escalation of antibiotic therapy in critically ill patients with sepsis to avoid both antibiotic overuse and antibiotic related side effects. Review of current literature shows that procalcitonin is efficacious in reducing duration of antibiotic therapy in patients with sepsis in the ICU setting. This result, however, is not being observed in clinical practice. This discrepancy is due to the inappropriate use of procalcitonin that does not align with use outlined in randomized control trials. We propose a study to determine how procalcitonin is being used in clinical practice in four Boston area hospital Intensive Care Units. Through chart review, we will identify patients in the Intensive Care Unit with sepsis from 2013-2018 recording patient demographic information and patient characteristics. We will determine whether they had PCT measured during their stay, and if they did, whether or not discontinuation of antibiotics was in accordance with FDA’s proposed algorithm. We will aim to compare whether discontinuing antibiotic therapy in accordance with the FDA’s procalcitonin deescalation algorithm is associated with reduced duration of antibiotic therapy or incidence of Clostridium Difficile infection. In conducting this study, we hope to identify patterns of procalcitonin use in clinical practice and provide further evidence that using the algorithm to guide therapy can serve as an effective tool in reducing exposure to unnecessary antibiotics and the complications from their use.

Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one’s institution.

With an increasing number of antimicrobial stewardship-related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an "actionable" intervention for 2017. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the "actionable" intervention used by antimicrobial stewardship programs to provide key stewardship literature for training and teaching and identify potential intervention opportunities within their institutions.

Magister Pharmaceuticae - MPharm / Antibiotic resistance (ABR) is a global healthcare burden complicating the treatment of various infections. The infectious diseases burden is heavy in primary care. Urinary tract infections (UTIs) are common outpatient infections. Miscommunication in healthcare may lead to non-adherence, adverse events and fuel ABR. Labelling antibiotics should be explicit and understood by patients. Treatment of UTIs in primary care in the Western Cape is not well defined. This study’s aim is to describe the treatment of UTIs in primary care in the Cape Metropole of the Western Cape province.

Best Practices: Antibiotic Stewardship and the Implementation of Evidence-Based Guidelines During Upper Respiratory Infections Among Rural, Primary Care Patients Sandra Kay Johnson, Doctor of Nursing Practice Candidate East Tennessee State University College of Nursing Abstract Antimicrobial resistance is a challenging clinical issue seen in the treatment of upper respiratory infections (URIs). Purpose/Aims: The purpose of this project is to implement an antibiotic stewardship (AS) program using antibiotic prescribing guidelines for URIs and clinic-wide patient education. The aim was to reduce antibiotic overuse. Processes: This quality improvement (QI) project was conducted at a rural clinic. Participants included the nurse practitioners and office staff. The target population included adult patients, ages 18 and up, who presented with upper respiratory symptoms. URI prescribing guidelines were used to compare antibiotic prescribing practices pre- and post-intervention. The initiative includes a provider education session and educational videos, posters, and scientific literature, which is available to those assessing the clinic. Educational materials were from the Centers for Disease Control and Prevention, the United States Department of Health and Human Services, and the National Center for Emerging Zoonotic Infectious Diseases. The Knowledge-to-Action framework was used to translate research into practice and data was collected through the administration of questionnaires and the review of EMRs. Results: Preliminary results suggest patient preferences, outside of guidelines, may influence prescribing behaviors. Limitations: The sample of providers was small and may not be characteristic of a larger group. Conclusions: This QI initiative was driven by the need to improve practice and educate patients regarding AS during upper respiratory-related illnesses. Preliminary evidence shows interventions such as patient education, implementation of guidelines, and identification of barriers and facilitators are all vital components of AS.

Antibiotics are commonly prescribed and requested for viral illnesses despite evidence-based research studies and societal guidelines that advise against this practice. Literature has indicated that antibiotic decision-making comes from a provider's experience or exposure to illness, uncertainty of illness, or from being pressured by the patient. Nurses and advanced practice nurses are important participants in the antibiotic stewardship initiative. The purpose of this project was to examine potential knowledge deficits responsible for inappropriate antibiotic prescribing at a rural urgent care clinic in the southeastern United States, which when addressed could promote an educational in-service to decrease the number of antibiotics prescribed during a high-volume cough, cold, and flu months. The health belief model was used as a foundational model and a knowledge, attitude, and practice survey to collect data. Antibiotic prescribing habits were evaluated in the preintervention group (n = 250) and a year later in the postintervention group (n = 265). Antibiotic prescribing decreased positively from 80% to 70% and watchful waiting also increased positively from 4% to 30%; X-² (1) = 12.302, p = .000. The increase in educational awareness from these results can support a decrease in inappropriate antibiotic prescriptions, which prevents the emergence of antibiotic-resistant bacteria, contributing to positive social change.

The shift from the paradigm ofthe Enlightenment (modernity) to post-modernity will have a significant impact on the concept and practice of stewardship in the church and in the theological seminary. This thesis project examines fund-raising under the emerging paradigm and offers proposals for the raising of funds for McMaster Divinity College. It does so by looking at current and potential donor sources in addition to examining and suggesting methodologies to assist in underwriting the visions and purposes ofthe College. As a background, the study presents a brief analysis ofthe philosophical and theological roots of McMaster Divinity College. This is done by considering a number of the influences common to most theological schools founded in conjunction with North American universities in the 19th century. The influences peculiar to McMaster are considered as well. The thesis project also examines several points of conflict that have arisen periodically between the College and its long-time sponsor, the Baptist Convention of Ontario and Quebec, in order to understand better the relationships between the two institutions. This is accomplished by consideration of their legal relationship and the circumstances leading to a denomonational schism in 1927, the Sunday school "curriculum controversy" of 1964-65, and, more recently, the so-called Bishop Robinson controversy of the mid-1980s. The meaning of stewardship has changed both in its theological concept and its usage in society. It continues to change. Several theologians and biblical scholars ofthe post-modern era are returning to a more biblically informed understanding ofstewardship with its much greater emphasis on accountability and responsibility, not only for the use of personal resources such as money and property, but for all the resources that God has entrusted to his people. The theological school likely will continue to be the primary training institution for Christians who desire more formal theological education but the churches likely will wish to see those teaching in and administering the Divinity College model the qualities ofthe Christian steward. That probability will be a major factor for recruitment and financial support. / Thesis / Doctor of Ministry (DMin)

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