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Updated: Jan 22, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Collaborative Solutions to Antibiotic Stewardship in Small Community and Critical Access Hospitals
Jay Bhatt1, Brian Smith, Melinda M Neuhauser
1J. Bhatt is senior vice president and chief medical officer, American Hospital Association, Chicago, Illinois. B. Smith is a law student, University of Illinois College of Law, Urbana-Champaign, Illinois. M.M. Neuhauser is a pharmacist and acute care lead, Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. A. Srinivasan is associate director, Healthcare Associated Infection Prevention Programs, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. P. Moore is senior health advisor, Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland. D.Y. Hyun is senior officer, Pew Charitable Trusts, Washington, DC.
Abstract:
The overuse and misuse of antibiotics affect patients in many ways, including by driving antibiotic resistance, a serious public health threat in the United States and around the world. To improve patient safety and address rising rates of resistance, an increasing number of health care facilities have created antibiotic stewardship programs (ASPs). ASPs have been successful in slowing the emergence of resistance and improving patient outcomes. However, there are serious geographic and resource barriers to ASP adoption in small community hospitals and critical access hospitals. Fortunately, many barriers can be overcome by using collaborative models to bring together key stakeholders, including large hospitals and health systems and academic medical centers; hospital associations; federal, state, and local public health organizations; and federal and state offices of rural health. These stakeholders are ideally positioned to assist with stewardship efforts in small community and critical access hospitals and, in doing so, can improve patient safety while stemming the spread of resistant bacteria.
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Assessment:
Critical Region, Critical Values and Significance Level
In hypothesis testing, a sample statistic is converted to a test statistic using z, t, or chi-square distribution. A critical region is an area under the curve in probability distributions demarcated by the critical value. When the test statistic falls in this region, it suggests that the null hypothesis must be rejected. As this region contains all those values of the...

