Infectious Diseases

Posted by Omo at Saturday, April 02, 2011



My seventh rotation was at Sinai Grace Hospital in Detroit. I got the opportunity to work with the Infectious Disease pharmacist, focusing on antimicrobial stewardship. It was a very rewarding experience. I engaged in daily patient work-ups where I was assigned about three different patients everyday. Similar to other clinical rotations, I had to go through each patient’s profile and analyze their medication history with big emphasis on their antibiotic medications. I would go through blood cultures, urine cultures and sputum cultures to see if the antibiotic(s) the patient was on had good coverage against the bugs grown. The choice of antibiotic was not only based on good coverage. Like any other hospital, it was also dependent on what was on formulary, cost, patient’s renal function etc. So there was a lot to consider. Streamlining was another big part of the antimicrobial stewardship. It involved choosing the best antibiotic to cover the patient’s bug without broad-spectrum coverage to prevent resistance to drugs. If a patient was on a broad-spectrum antibiotic and a much narrow spectrum antibiotic could do the same coverage (after cultures have been thoroughly examined), we would de-escalate the patient’s therapy. De-escalate is synonymous to streamlining. For any intervention we made, we would consult with the ID physician and most times, they would take our recommendation for change.

Besides patient case work-ups, we also did daily discussions covering several ID topics such as Clostridium difficile, candidiasis, meningitis, endocarditis, pneumonia and intra-abdominal infections to name a few. My partner and I would teach each other the topics and our preceptor would add to the discussion after we each presented. We also did journal club presentation for the pharmacy staff mostly but some ID physicians at the hospital also showed up.

Overall, this rotation was a very rewarding learning experience. Unlike most clinical rotations, we didn’t get the opportunity to go on rounds with the medical team for several reasons but I still got a lot out of the rotation and I am grateful for such exposure.