Antimicrobial Resistnce Flashcards
What causes resistance?
ANY exposure to this antibiotic will cause resistance. This is why use right antibiotic with as smaller spectrum as possible. Resistance is irreversible.
What are the consequences of antibacterial resistance?
Treatment failure
Prophylaxis failure
Economic cost.
MRD?
Multi-drug resistant
NON-susceptibility to at least one agent in three or more anti microbial categories.
XDR?
Extensively drug resistant
Non-susceptibility to at least one agent in all but two or fewer antimicrobial categories.
PDR?
Pan-drug resistant
Non-susceptibility to all agents in all antimicrobial categories.
What is Stewardship?
Optimum and appropriate use of antibiotics.
What evidence is there that antibacterial 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).
Individual level data
Found that when somebody is prescribed antibiotics for UTI or resp infection is linked to resistance.
Longer durations and multiple courses are associated with higher resistance.
What is the IDSA definition of antimicrobial stewardship?
Coordianted interventions designed to imporve 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, minimise toxicity and other adverse events, reduce the costst of healthcare for infections and limit the selection for antimicrobial resistant strains.
Elements of antimicrobial stewrdship program?
MDT
Surveillance - process measures and outcome measures
Interventions - Persuasive, Restrictive and Structural
MDT?
Medical Microbiologists / infectious disease physician
Antimicrobial pharmacists
Infection control nurse
Hospital epidemiologist
Information system specialist
What are the types of stewardship interventions?
Persuasive - Education, Consensus, Opinion leaders, Reminders, Audit Feedback,
Restrictive - Restricted susceptibility reporting -eg only report 2/6 drugs it is sensitive too, Formulary restriction, Prior authorisation - need code from microbiology, Automatic stop orders - If course is too long
Structural - Computerised records, Rapid lab tests, Expert systems, Quality monitoring
Process measures?
Antibacterial use.
Quantity - defined daily dose / 1000 bed days.
Antibacterial classes
Appropriateness: adherence to guidelines
Over time in same institution
Benchmarking against other institutions.
What are the requirements for successful stewardship?
Long term confirmed and appropriate resources
Hospital leadership support and delegated authority to challenge / change inappropriate antimicobial therapy
Integration into organisational patient safety and quality of care structure and process
What outcomes are more effective?
Restrictive outcomes are more affective than persuasive outcomes for the first 6 months.
After 12 months, not that much difference.
