Krista Gens, PharmD, BCPS, BCIDP, DPLA: Stories of Antibiotic Use and Resistance

As a specially trained infectious diseases pharmacist, my role is very specialized and is different from what most people think of as the typical pharmacist functions. My entire job is focused on antibiotic stewardship. Primarily, I review hospital charts and serve as an expert “double check” to ensure the most appropriate antibiotics are selected, dosed, and stopped as soon as possible. I only review orders for antimicrobials, and I do not prepare or dispense any medications. Secondly, I am also a residency program director, so I have the honor and privilege of teaching and coaching others to go on and do the same. Finally, I serve as a leader to help drive changes related to antibiotics across the health system. The ultimate goal of all these aspects of my position is to prevent antibiotic resistance.

In my role, I have to give a lot of “unsolicited advice” to providers, so there is a unique skill set that is cultivated through these interactions. I have to convey that I am here to offer help, we are on the same team, and I am not here to criticize their choices. I also have to recognize that I may not have the entire clinical picture just from reading the chart, so there is a fine line I must walk when offering my suggestions. But often providers may not realize there are opportunities to change patients’ antibiotic regimens for the better, so I am here to help identify those opportunities.

While most of my job is focused on using the most narrow antibiotic(s) possible and helping pick the best antibiotic for each patient, I also help when there are patients that need very broad, expensive, and uncommon antibiotics. Some infections are so resistant and some antibiotics are so new that I have to facilitate getting difficult to obtain antibiotics for the patient as quickly as possible. Sometimes we do not have the capability to test in the lab, so I have to work with lab to help make that possible. Other times single drugs to treat these infections aren’t even available, so I help the provider come up with combination therapy regimens by helping them research available literature. Or sometimes I even have to help obtain investigational agents through a compassionate use program. It can be a difficult time for patients (and providers and pharmacists!) in this scenario, and I am here to help get the right drug to the right patient as quickly and as safely as possible.

My job exists because of antibiotic resistance! But beyond my job functions described above, being involved in organizations like the Minnesota One Health Stewardship Collaborative has helped me gain a holistic perspective on antibiotic use and antibiotic resistance across human, animal and environmental health. Because of this, I have been able to collaborate with professionals outside of human health care to help foster collaboration for antibiotic stewardship in other arenas as well, and this has been both professionally and personally very rewarding.

I worry about what our world could look like if we have limited antibiotics that work anymore, and I always worry there will not be an antibiotic that works for one of our patients with an extremely resistant infection.

Ultimately, if we could immediately know exactly what antibiotic the patient needed at the very first instant antibiotics were prescribed, we could prevent so much unnecessary antibiotic exposure and so much antibiotic resistance! Rapid diagnostics are going to be a key piece in our fight against antibiotic resistance.