Antimicrobial Resistance And Stewardship Flashcards
How are most antibiotics discovered
They exist in the environment originating from 2-40 mil years ago. Takes time and Money to discover
When does resistance emerge
Resistance inevitably immerses soon (few years) after the antibiotic is introduced into clinical practice
What drives antimicrobial resistance?
All exposure of bacteria to antimicrobials - any exposure will drive resistance
When we use antibiotics we have to use the right one for the right infection
What are the consequences of antibacterial resistance?
Treatment failure, prophylaxis failure, economic costs
What does MDR (multi-drug resistant) mean?
Non-susceptibility to at less one agent in 3 or more antimicrobial categories
Define XDR (extensively drug resistant)
No-susceptibility to at least one agent in all but 2 or fewer antimicrobial categories
Define PDR (pan-drug resistant)
Non-susceptibility to all agents in all antimicrobial categories
What is the evidence that antibacterials cause resistance
• Laboratory evidence
– Provides biological plausibility
• Ecological studies
– Relates levels of antibacterial use in a population with levels of resistance
• Individual level data
– Relates prior antibacterial use in an individual with the subsequent presence of bacterial resistance (detected by culture or molecular means)
Outline an ecological study for the relationship between prior antimicrobial use and resistance
Relationship between prior antimicrobial use and resistance in Streptococcus pneumoniae in Finland, 1997-2002
• Regional rates of consumption of penicillins, cephalosporins and
macrolides estimated from sales figures
• S pneumoniae penicillin and macrolide resistance data collected from 26 labs nationally
• Previous year antibacterial use compared with resistance rates
• Macrolide and azithromycin use were associated with increased
macrolide resistance on a regional level.
• Beta-lactam and cephalosporin use associated with increased rates of low-level penicillin resistance.
• High-level use of penicillins was not connected to increased rates of low-level penicillin resistance
Outline some individual level data for the relationship between prior antibacterial exposure and resistance
Systematic review and meta-analysis of relationship between prior antibacterial exposure and resistance in individual patients in primary care
• 24 studies reviewed
• Antibiotics prescribed in community for urinary tract or
respiratory tract infections are linked with increased rates of carriage of resistant bacteria in recipient patients for up to 12 months
• Longer durations and multiple courses associated with higher
resistance rates
Different antimicrobial stewardship
IDSA definition of antimicrobial stewardship
• Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains.
What are the objectives of antimicrobial stewardship?
- appropriate use of antimicrobials
- optimal clinical outcomes
- minimize toxicity and other adverse events
- reduce the costs of health care for infections
- limit the selection for antimicrobial resistant strains.
What are the elements of an antimicrobial stewardship programme
- Multidisciplinary team and relationships to other quality/safety teams
- Surveillance
- Process measures
- Outcome measures
- Interventions
- Persuasive
- Restrictive
- Structural
Who are the MDT for antimicrobial stewardship
- Medical Microbiologist/Infectious diseases physician
- Antimicrobial pharmacist
- Infection control nurse
- Hospital epidemiologist
- Information system specialist
What are the stewardship intervention types?
Persuasive
- education
- consensus
- opinion leaders
- reminders
- audit
- feedback
Restrictive
- restricted suseptibility reporting
- formulary restriction
- prior authorisation - eg a code needed to be verified before usage
- automatic stop orders - so a patients prescription is stopped when the antimicrobials are no longer needed
Structural
- computerised records
- rapid lab tests
- expert systems
- quality monitoring
