This proposal is part of an integrated career development plan comprised of advanced didactic training in clinical investigation and an intensive, mentored patient-oriented research experience with the goal of developing the skills and experience necessary for a successful, independent career in clinical investigation. The candidate's goal is to establish an independent, successful research program focusing on antimicrobial utilization and resistance. ? Didactic training will be undertaken as part of the research career development plan in order to extend upon the candidate's existing foundation in clinical research which was obtained through the Master of ? Science in Clinical Research (MSCR) degree. This additional didactic training provides the opportunity to study other technical and methodologic components integral to the proposed clinical research including outcomes research, cost-analysis, and behavioral epidemiology. The candidate's mentor and internal advisory committee are well-recognized, established clinical researchers in infectious diseases who are committed to fostering the candidate's career development and critically assessing the candidate's progress and ongoing research. Training in outcomes research at the Emory Center for Health Outcomes and Quality represents the final component of the candidate's research career development plan. Antimicrobial resistance and inappropriate antibiotic use are major public health problems. The most effective methods to improve antibiotic use and reduce antimicrobial resistance remain unclear. The purpose of this project is to determine if antimicrobial utilization teams improve antibiotic use and patient outcomes and reduce antimicrobial resistance. This investigation proposes to (1) conduct a randomized trial comparing the efficacy of a multidisciplinary antimicrobial utilization team versus indication based antibiotic prescribing guidelines in improving antibiotic use and reducing the cost of medical care, and (2) conduct an interventional study to determine the impact of a multidisciplinary antimicrobial utilization team rounds in the intensive care unit on antimicrobial utilization, total costs of antimicrobial therapy, and rates of resistance in nosocomial pathogens. ? ? ?
