Anrimicrobial Stewardship Flashcards
Define Stewardship
Appropriate selection, dosing, route and duration of antimicrobial therapy
What is the primary goal of stewardship?
Primary goal is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use, including s/e and toxicity, the selection of pathogenic organisms (such as Clostridioides difficile) and the emergence of resistance
Define antimicrobial resistance
the ability of a microorganism to withstand the effects of antimicrobials to kill or inhibit their growth
What occurs when an individual ingests an antibiotic?
When a patient ingests an antibiotic, susceptible organisms are killed or inhibited while resistant organisms remain and can thrive (does not matter if use is appropriate or not)
This happens regardless of appropriateness
In regards to antimicrobial resistance, what becomes resistance?
- The microorganism
- Not the antibiotic or the person
What are the benefits of antimicrobial stewardship?
Improved patient outcomes
Reduced adverse events including C. difficile infection
Improvement in rates of antibiotic susceptibilities to targeted antibiotics
Optimization of resource utilization
What are the consequences of antimicrobial misuse and resistance?
More severe illness; longer recovery time
May require hospitalization or prolong hospitalization
More HCP visits
Need to use more toxic antibiotics
More deaths
What are some interventions that institutions can develop?
Preauthorization –> can only prescribe if have consultation with ID physician or pharmacist
Prospective audit and feedback
Clinical practice guidelines (facility specific) with dissemination and implementation strategy
Computerized clinical support –> hospitals with computer order –> system asks a bunch of questions
Target specific patient groups or drugs
What is the pharmacists role in antimicrobial stewardship?
Patient Education
Educating yourself about what’s in the community at the time
Assessing appropriateness and necessity of an antibiotic
Educating other healthcare practitioners
Know the indication, patient knows indication, how to use the medication
Helping prevent infections in the first place (safer sex, wearing masks)
Vaccination
What are some principles of preventing infection?
If an infection doesn’t develop – no need to prescribe antibiotics
VACCINATION
Hand hygiene/ cough and sneeze etiquette
Safer sex
Describe the principle of “select the shortest effective duration”
Longer is not better
No evidence that resistance develops with shorter duration of therapy
‘finish the antibiotics even if you feel better’ – probably not the best instructions
How to correctly assess an antibiotic allergy?
Many patients do not receive first line beta-lactam antibiotics due to labelling as allergic
Many ‘allergies’ are intolerances and not true allergies
Allergies due to cross-reactivity to side chains and not the beta-lactam ring structure
What are some strategies for microbial stewardship?
Watchful waiting or delayed prescribing –> Give antibiotic but educate to not use unless gets worse –> “DO not fill until….”
Non- antimicrobial recommendations Still need care, different strategies
Physician feedback on prescribing (compared to their peers)
Improved communication between the patient and HCP
Showing commitment to stewardship
Education – HCP and consumers
