“Ninjas” work in the shadows to keep Riley kids safe




Infectious disease team receives the gold seal of excellence for its guidance on the proper use of antibiotics and other medicines.

By Maureen Gilmer, IU Health senior writer, mgilmer1@iuhealth.org

In a world of “smart bugs” and wily germs, a team of Riley Children’s Health physicians and pharmacists wage battle daily on behalf of Riley patients and families.

“We’re kind of ninjas working in the background,” said Riley clinical pharmacist Michelle Kussin. “As a patient, you might not see us come to the bedside, but we’re always there supporting your team, reviewing your antibiotics, making sure that you’re getting the right thing.”

The focus of this team’s behind-the-scenes work is ensuring the safety and efficacy of antibiotic/antimicrobial use in patients. Antimicrobials encompass antibiotics, antifungals and antivirals (think remdesivir, used against COVID-19).

Because of the team’s diligence, innovation and leadership, Riley has been awarded the designation of Antimicrobial Stewardship Center of Excellence by the Infectious Diseases Society of America.

It’s a mouthful, we know, but it’s another feather in Riley’s cap, evidence of the hospital’s commitment to safety and excellence in the care of children.

“Something we try to emphasize is, of course, antibiotics have great benefits when indicated and used appropriately,” said Kussin, who works with Riley’s Infectious Diseases department and is co-director of the Pediatric Antimicrobial Stewardship Program.

“But when they’re overused, when an antibiotic is not actually going to help that patient’s symptoms or when the wrong antibiotic or the wrong duration is chosen, really there are a lot of side effects to not only that patient, but the whole community,” she explained.

That’s because germs are tricky. They get smart, Kussin said, so the more you use an antibiotic in the community, the more those germs in that household, that neighborhood or that region become resistant as a population, so they’re no longer killed by those same antibiotics.

“It’s OK to ask your provider, do I really need this antibiotic, or what side effects should I be looking for,” she said.

Dr. Jack Schneider, medical director for the stewardship program within the Ryan White Center for Pediatric Infectious Diseases and Global Health, wants families to know why this recognition should matter to them.

“For those families who come into Riley, I think they should feel confident knowing we are recognized for the way we prescribe our antibiotics and antimicrobials,” he said. “Antibiotics can be harmful and that’s why we have to be judicious in how we prescribe them for certain infections.”

This distinction should reassure parents that if antibiotics are indicated for their child, measures are in place to ensure the appropriate medication is chosen at the optimal dose and duration, he said.

“Riley and IU Health are dedicated to equipping the diagnostic microbiology lab with the most advanced testing platforms to detect pathogens sooner,” he said. “Thanks to our practices and policies, patients are getting better faster with fewer side effects. And we are preserving our current antibiotics so that future infections can be appropriately treated.”

The stewardship team, which also includes infectious disease physicians Samina Bhumbra and John Christenson, monitors prescribing practices, current resistance rates, and standardized treatment guidelines for patients with certain infections.

“We really engage with all of our specialty teams here and help educate providers to choose and prescribe the right antibiotic, at the right dose and for the right duration – all based on the most up-to-date treatment practices,” Dr. Schneider said.

He adds that antimicrobial resistance is among the biggest threats to global health today.

Dr. Elaine Cox, chief medical officer for Riley and a former infectious disease physician, was the first stewardship director for Riley a decade ago. She has continued to support the group’s initiatives from a leadership role, which Dr. Schneider appreciates.

When he took over as medical director of the antimicrobial stewardship team in 2020, he realized that Riley had the potential to achieve Center of Excellence status in the eyes of the Infectious Diseases Society of America, making it one of 10 pediatric hospitals in the world with the designation, he said.

While many aren’t aware of the stewardship program and its focus on proper prescribing, tracking and education on the use of antibiotics and other medicines, the recognition is “a reflection of the collaborative efforts of many specialties here at Riley,” Dr. Schneider said. “They all work closely together to develop and implement a variety of initiatives to really combat antimicrobial resistance and just really provide overall better care for our patients.”

Kussin said the seal of excellence should reassure families that their child is receiving the best care at all levels while at Riley. While their individual care team – be it heart, cancer or any of Riley’s top-ranked specialties – will have experts in that field, infections can affect any patient, and right-size care when it comes to antibiotics and other medicine makes a difference.

“Our expertise comes with them to whatever service line they may be coming to Riley for,” she said.

However, she cautioned, antibiotics will NOT make you feel better if you have:

  • Common cold
  • Runny nose
  • Flu
  • COVID-19
  • Sore throat (except strep throat)
  • Mild ear infections

They can, in fact, make you feel worse if adverse effects like diarrhea, tingling of the hands and feet, rash, allergic reactions and sensitivity to sunlight kick in.

Many parents are trying to be great advocates for their kids, and they think, “I’m not walking out of here without amoxicillin,” Kussin said. But if it’s a virus, an antibiotic will have zero effect.

That’s why educating parents at the point of care is so important to head off those emotionally charged conversations when a child is ill.

COVID, of course, created new challenges for healthcare workers, including those whose duty is to ensure that the right medicines are being prescribed.

“As hospitals continue to respond to the COVID-19 pandemic, we are reminded that antimicrobial resistance threatens our ability to treat patients each and every day,” said Dr. Barbara Alexander, president of the Infectious Diseases Society of America.

“IDSA continues to prioritize fighting antimicrobial resistance through research, education, training and policy initiatives. Our Centers of Excellence program recognizes hospitals that are joining us in that fight.”

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org