Antibiotic Stewardship Flashcards
How long have antibiotics been around?
2 billion - 40 million years
How is it that medical professionals are increasing antimicrobial resistance?
Every time antimicrobials are used we are selecting for the resistant strains.
What do we mean when we say antimicrobial development has stalled?
We have made no new anti microbial in recent years (1987) also known as the discovery void.
What are the consequences of antimicrobial resistance?
Treatment fails
Prophylaxis fails
Increased cost
When describing resistant strains what categories can we label the microbes as?
Multi-drug resistant- not susceptible to one or more antimicrobial in three or more categories.
Extensively drug resistant- not susceptible to one or more antimicrobials in all but two antimicrobial categories.
Pan drug resistant - not suceptibale to any known antimicrobial
What does antibiotic stewardship presume?
Antibacterial used leads to resistance
How have we evidenced the link between the use of antibacterials and increasing resistance?
Lab studies give biological plausibility.
Ecological studies relates the levels of antibacterial use to the level of resistant strains in the population.
Individual level date shows people who have used antibiotics are more likely to carry resistant strains.
Define antimicrobial stewardship
Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting section of the optimal antimicrobial agent regimen, dose, duration and route of administration. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimise toxicity and adverse effect, reduce cost of healthcare related to infections and limit selection for resistant strains.
List the objectives of antimicrobial stewardship
Appropriate use of antimicrobials Optimal clinical outcomes Minimise adverse effects and toxicity Reduce costs for infection related health care Limit selection for resistant strains
What types of surveillance to we have for antimicrobial stewardship?
Process measures
- antimicrobial use
- quantity or dose
- guidelines
- antibacterial classes
Outcome measures
- patient outcomes
- resistance emergence
- c diff rates
What types of antimicrobial stewardship interventions are there?
Persuasive
Restrictive
Structural
Who is in the antimicrobial stewardship MDT?
Medical Microbiologists Infectious disease specialists Antimicrobial pharmacists Infection control nurses Hospital epidemiologists Information system specialists
How do we help stop the spread of resistant strains?
Environmental decontamination, Infection prevention and antimicrobial stewardship.
Describe features of persuasive interventions in antimicrobial stewardship.
Education consensus Opinion Leaders Reminders Audit Feedback
What are restrictive interventions in antimicrobial stewardship?
Formulary restrictions
Prior authorisations
Automatic stop orders
Restricted susceptibility repoting
