Antimicrobial Stewardship Flashcards
Antimicrobial stewardship definition
Effort to measure and improve how ABX are prescribed by clinicians and used by patients
Core elements of ABX stewardship
Hospital leadership commitment Accountability Pharmacy expertise Action Tracking Reporting Education
Hospital leadership commitment
Making sure the hospital is providing necessary resources to the antimicrobial stewardship team in order for them to accomplish their goals
Accountability
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
Pharmacy expertise
Pharmacy leader should be identified
Action: prospective audit and feedback
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
Action: preauthorization
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
Restricted ABX
Broad-spectrum ABX, costly ABX, ABX on shortage
Dapto, meropenem, tigecycline
UTI interventions
Don’t treat unless you’re pregnant, new kidney transplant, planned urologic procedure; avoid obtaining unnecessary urine culture
SSTIs interventions
Prescribing correct route, dosage, and duration of treatment; avoid broad-spectrum ABX in uncomplicated infections
LRTI interventions
Tailor therapy to culture results, obtain MRSA nares, optimize duration of treatment
Tracking
Monitor ABX use and resistance patterns
Reporting
Report info on antimicrobial use and resistance regularly to hospital personnel and leadership
Education
Most effective when paired with interventions and measurement of outcomes
When to switch from IV to PO
When the patient is clinically stable/improving and no concern for PO absorption exists
Drugs with good IV to PO bioavailability
Macrolides Metronidazole Linezolid Fluoroquinolones TMP/SMX Doxycycline
Duration of therapy
Shorter=better
ABX with NO renal dose adjustment
Clindamycin Ceftriaxone Oxacillin Moxifloxacin Metronidazole Azithromycin Nafcillin Doxycycline Erythromycin Dalfopristin/quinipristin Tigecycline Linezolid
What to do with patients with a severe PCN allergy
Use alternative agent or desensitize the patient if no other acceptable beta-lactam options are possible
What to do with patients with a non-severe PCN allergy
Give them a cephalosporin or carbapenem
PCN allergy assessment questions
What occurred when you received the PCN?
What age did it happen?
What other ABX have you taken?
Review med profile
MSSA: definitive treatment
Dicloxacillin
Oxacillin
Nafcillin
Cefazolin/cephalexin
MRSA: definitive treatment
Vanco, dapto, linezolid, ceftaroline, clindamycin, doxycycline, TMP/SMX, dalbavancin, oritavancin, tigecycline, delafloxacin, quinupristin/dalfopristin
Streptococci: definitive treatment
PCNs, cephalosporins, vanco, moxifloxacin, levofloxacin
Enterococci: definitive treatment
Ampicillin, amoxicillin, dapto, linezolid, vanco, fosfomycin
Pseudomonas: definitive treatment
Pip/tazo, cefepime, ceftazidime +/- avibactam, ceftolozane/tazo, doripenem, imipenem/cilastatin, meropenem, fosfomycin, AGs, quinolones
