Antibiotic Resistance and Antimicrobial Stewarding

Question 1

Other than treating infection, what are antibiotic used for?

Answer 1

Cancer chemotherapy
Immunotherapy
Organ transplantation

Question 2

How is resistance defined from a biological perspective?

Answer 2

In vitro quantitative testing of bacterial suspicions to antibacterial agents

Question 3

What is minimum inhibitory concentration?

Answer 3

The minimum concentration of a drug which inhibits the growth of the microorganism

Question 4

What is the breakpoint of an antibiotic?

Answer 4

The concentration of an antibiotic which defines whether a species is sensitive or resistance

Question 5

How is resistance defined clinically?

Answer 5

When infection is highly unlikely to respond even to maximum doses of antibiotic

Question 6

List methods used by bacteria to become resistant

Answer 6

Efflux pumps
Decreased uptake of antibiotic
Inactivating enzymes
Alternative enzymes
Target alterations

Question 7

What methods can bacteria use to transfer resistance to other bacteria?

Answer 7

Transduction
Transformation
Conjugation

Question 8

Give an example of transduction which results in resistance

Answer 8

Bacteriophages can transfer the tetracycline R gene into E.coli and salmonella resulting in resistance via the use of an efflux pump

Question 9

Give an example of transformation which results in resistance

Answer 9

Pneumococci bacteria change the penicillin binding proteins in order to become resistant to penicillins

Question 10

How are beta lactamases in enterobacteriaceae inherited?

Answer 10

Conjugation

Question 11

Unnecessary antibiotics are associated with avoidable toxicity. T/F?

Answer 11

True

Question 12

What types of infection can carbapenemase resistant enterobactericeae cause?

Answer 12

Bacteraemia
Pneumonia
UTIs
Wound infection

Question 13

How can carbapenemase resistant enterobactericeae be transmitted?

Answer 13

Direct contact

Indirectly via contaminated environmental surfaces or shared equipment

Question 14

What is antimicrobial stewardship?

Answer 14

The systematic approach to safe and effective use of antibiotics which optimises outcome, minimises harm and preserves future therapies

Question 15

How is antimicrobial stewardship achieved?

Answer 15

Monitorting/surveillance
Guidlines/protocols
Specific restrictions
Specific interventions
MDTs

Question 16

What is the role of the laboratory in antimicrobial stewardship?

Answer 16

Optimisation of lab diagnosis to minimise over diagnosis
Restricted reporting of organisms to prevent over treatment
Restricted reporting of sensitivities to reduce the sue of in appropriate agents
Coordination of clinical advice with guidance
Data on resistance

Question 17

Give examples of situations in which antibiotics should not be prescribed?

Answer 17

Viral and self-limiting bacterial RTIs
Asymptomatic bacteruria
Uncomplicated Cystitis 
Catheter associated UTI
In growing toenails
Leg ulcers without cellulitis
Varicose eczema
Systemic inflammatory response due to cancer ischaemia or inflammation

Question 18

What measures could be used instead of antibiotics?

Answer 18

Reassurance and explanation
Symptomatic measures such as fluids/analgesia
Delayed antibiotic script
Review date

Question 19

What human factors can act as a barrier towards antimicrobial stewardship?

Answer 19

Knowledge
Experience
Prescribing culture
Hierarchy
Team work
Perception of role and responsibility

Question 20

What narrow spectrum antibiotics could be used to treat lower respiratory tract infections?

Answer 20

Amoxicillin or doxycycline

Question 21

What narrow spectrum antibiotics could be used to treat mild cellulitis?

Answer 21

Flucloxacilin

Doxycycline