Antimicrobial Stewardship

Question 1

Antimicrobial stewardship definition

Answer 1

Effort to measure and improve how ABX are prescribed by clinicians and used by patients

Question 2

Core elements of ABX stewardship

Answer 2

Hospital leadership commitment
Accountability
Pharmacy expertise
Action
Tracking
Reporting
Education

Question 3

Hospital leadership commitment

Answer 3

Making sure the hospital is providing necessary resources to the antimicrobial stewardship team in order for them to accomplish their goals

Question 4

Accountability

Answer 4

Have to have a designated leader or co-leaders who are accountable for management of the program and its outcomes

Usually co-lead with a physician and a pharmacist that meet a couple times a week

Question 5

Pharmacy expertise

Answer 5

Pharmacy leader should be identified

Question 6

Action: prospective audit and feedback

Answer 6

Trained staff review ABX orders and provide written/verbal recommendations to providers

The providers don’t have to take the recommendation which helps them retain their clinical decision making and autonomy

Question 7

Action: preauthorization

Answer 7

Approval is required by an ID pharmacist/physician before administration

Allows for optimization of initial choice of antimicrobial therapy and for pharmacists to intervene and educate prescribers about appropriate antimicrobial use

Question 8

Restricted ABX

Answer 8

Broad-spectrum ABX, costly ABX, ABX on shortage

Dapto, meropenem, tigecycline

Question 9

UTI interventions

Answer 9

Don’t treat unless you’re pregnant, new kidney transplant, planned urologic procedure; avoid obtaining unnecessary urine culture

Question 10

SSTIs interventions

Answer 10

Prescribing correct route, dosage, and duration of treatment; avoid broad-spectrum ABX in uncomplicated infections

Question 11

LRTI interventions

Answer 11

Tailor therapy to culture results, obtain MRSA nares, optimize duration of treatment

Question 12

Tracking

Answer 12

Monitor ABX use and resistance patterns

Question 13

Reporting

Answer 13

Report info on antimicrobial use and resistance regularly to hospital personnel and leadership

Question 14

Education

Answer 14

Most effective when paired with interventions and measurement of outcomes

Question 15

When to switch from IV to PO

Answer 15

When the patient is clinically stable/improving and no concern for PO absorption exists

Question 16

Drugs with good IV to PO bioavailability

Answer 16

Macrolides
Metronidazole
Linezolid
Fluoroquinolones
TMP/SMX
Doxycycline

Question 17

Duration of therapy

Answer 17

Shorter=better

Question 18

ABX with NO renal dose adjustment

Answer 18

Clindamycin
Ceftriaxone
Oxacillin
Moxifloxacin
Metronidazole
Azithromycin
Nafcillin
Doxycycline
Erythromycin
Dalfopristin/quinipristin
Tigecycline
Linezolid

Question 19

What to do with patients with a severe PCN allergy

Answer 19

Use alternative agent or desensitize the patient if no other acceptable beta-lactam options are possible

Question 20

What to do with patients with a non-severe PCN allergy

Answer 20

Give them a cephalosporin or carbapenem

Question 21

PCN allergy assessment questions

Answer 21

What occurred when you received the PCN?
What age did it happen?
What other ABX have you taken?
Review med profile

Question 22

MSSA: definitive treatment

Answer 22

Dicloxacillin
Oxacillin
Nafcillin
Cefazolin/cephalexin

Question 23

MRSA: definitive treatment

Answer 23

Vanco, dapto, linezolid, ceftaroline, clindamycin, doxycycline, TMP/SMX, dalbavancin, oritavancin, tigecycline, delafloxacin, quinupristin/dalfopristin

Question 24

Streptococci: definitive treatment

Answer 24

PCNs, cephalosporins, vanco, moxifloxacin, levofloxacin

Question 25

Enterococci: definitive treatment

Answer 25

Ampicillin, amoxicillin, dapto, linezolid, vanco, fosfomycin

Question 26

Pseudomonas: definitive treatment

Answer 26

Pip/tazo, cefepime, ceftazidime +/- avibactam, ceftolozane/tazo, doripenem, imipenem/cilastatin, meropenem, fosfomycin, AGs, quinolones