Antimicrobial Stewardship Flashcards
What is stewardship?
Appropriate selection, dosing, route and duration of anti microbial therapy
Primary goal of Stewardship
To optimize clinical outcomes while minimizing unintended consequences of anti microbial use including toxicity, the selection of pathogenic organisms and the emergence of resistance
What rate is an antibiotic prescribed where they were not indicated
1 in 4 in Canada
Antimicrobial Resistance (AMR)
The ability of a microorganism to withstand the effects of antimicrobials to kill or inhibit their growth
Benefits of Antimicrobial Stewardship Benefits
Improved patient outcomes
Reduced adverse events
Improvement in rate of antibiotic susceptibilities to targeted antibiotics
Optimization of resource utilization
Consequences of antibacterial overuse
More severe illness
Longer recovery time
May require hospitalization or prolong hospitalization
More HCP visits
Need to use more toxic antibiotics
More deaths
Recommended Team inpatient
Core - MD, clinical pharmacist with ID training
Addition
Clinical microbiologist
Information system specialist
infection control professional
Hospital epidemiologist
Examples of Intervention - institutional
Preauthorization
Prospective audit and feedback
Clinical practice guideline with dissemination and implementation strategy
Computerized clinical support
Target specific patient groups or drugs
Antimicrobial Stewardship Programs locations
Long term care facilities
Community (75% in outpatients)
Use the Best Drug (if a drug is needed)
First step is always to determine if an antibiotic is needed
Narrow spectrum rather than broad spectrum
Prevent Infection
If an infection doesn’t develop
- vaccination
- hand hygiene
- cough and sneeze etiquette
- safer sex
Select shortest effective duration
Longer is not better
Finish the antibiotics even if you feel better - might not be the best instructions
Correctly assessing antibiotic allergies
Many patients do not receive first line beta- lactation antibiotics due to labelling as allergic
Many allergies are intolerances and not true allergies
Strategies
Watchful waiting or delayed prescribing
Non-Antimicrobial recommendations
Physician feedback on prescribing
Improved communication b/w patient and HCP
Showing commitment to stewardship
Education - HCP and consumers
Principals of Stewardship
Use the best drug
Prevent infection
Select shortest effective duration
Correctly assessing antibiotic allergies
