Antimicrobial stewardship Flashcards
What is stewardship?
appropriate selection, dosing, route, and duration of antimicrobial therapy
What is the goal of stewardship?
deoptimize clinical outcomes while minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic orgs, and the emergence of resistance
What is anitmicrobial resistance?
the ability of a microorganism to withstand the effects of antimicrobials to kill or inhibit their growth
What are the benefits of antimicrobial stewardship?
improved patient outcomes
reduced adverse events including C. difficile infection
Improvement in rates of antibiotic susceptibilities to targeted antibiotics
Optimization of resource utilization
What are the consequences of antimicrobial misuse and resistance?
more severe illness and longer recovery times
may require hospitalization or prolong hospitalizations
More HCP visits
need to use more toxic ABs (tend to be more expensive)
More deaths
Who should be in the recommended inpatient team?
Core:
ID physician
clinical pharmacist with ID training
Optimal add:
Clinical microbiologist
information system specialist
infxn control professional
hospital epidemiologist
What are some examples of interventions at the institutional level?
Preauthorization
Prospective audit and feedback
clinical practice guidelines (facility specific)
with dissemination and implementation strategy
computerized clinical support
target specific patient groups or drugs
Where are ASPs seen?
In long term care facilities
In the community 75% of AB rx in Canada are for outpatients
List the pharmacists’ roles
Pt education
self-education about current situation in community
assess appropriate and necessity of a drug
educating other HCPs
ensure parties know the indication
preventative measures such as masking
vaccinations
What are the main principles of AMP
- use the best drug if a drug is needed - narrow > broad
- Prevent infxn - if no infnx then we don’t need AB
ex) vaccinations, hand hygiene, cough and sneeze etiquette, safer sex - select the shortest effective duration. Longer is not always better, always finish AB course
- correctly assess AB allergies - many allergies are actually intolerances, can switch out if only allergic to the side chain and not main structure
What are some strategies to achieve AMP?
Watchful waiting or delayed prescribing
non-antimicrobial recommendations
Physician feedback on prescribing
improved communication bet pt and HCP
showing commitment to stewardship
Education of HCP and consumers
