Antimicrobial Stewardship

Question 1

What is stewardship?

Answer 1

appropriate selection, dosing, route, and duration of antimicrobial therapy

Question 2

What is the goal of antimicrobial stewardship?

Answer 2

optimize clinical outcomes, while minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms, and the emergence of resistance

Question 3

What % of antibiotic prescriptions are inappropriate? What % of antibiotic prescriptions for respiratory infections are inappropriate?

Answer 3

30%
50%

Question 4

What is antimicrobial resistance?

Answer 4

the ability of microorganisms to withstand the effects of antimicrobials to kill or inhibit their growth
-antibiotics do not become resistant
-people do not become resistant to antimicrobials
when a patient ingests an antibiotic, susceptible organisms are killed or inhibited, while resistant organisms can remain and thrive

Question 5

What are the benefits of antimicrobial stewardship?

Answer 5

improved outcomes
reduced adverse effects including C.difficile infection
improvement in rates of antibiotic susceptibilities
optimization of resources

Question 6

What are the consequences of antimicrobial misuse and resistance?

Answer 6

more severe illness; longer recovery time
hospitalization or prolonged hospitalization
more HCP visits
need to use more toxic antibiotics
more deaths

Question 7

What are the interventions that can be implemented on a institutional level to improve antimicrobial stewardship?

Answer 7

preauthorization
prospective audit and feedback
clinical practice guidelines
computerized clinical support
target specific patient groups or drugs

Question 8

What are the principles of antimicrobial stewardship?

Answer 8

1. use the best drug, if a drug is needed
   -first step=determine if antibiotic is needed
   -narrow spectrum>broad spectrum
2. prevent infection
   -vaccination
   -hand hygiene/cough and sneeze etiquette
   -safer sex
3. select shortest effective duration
   -longer is not better
4. correctly assessing antibiotic allergies
   -many patients do not receive first line BLs due to labelled
   allergy
   -many “allergies” are intolerances

Question 9

What are some strategies to improve antimicrobial stewardship?

Answer 9

watchful waiting or delayed prescribing
non-antimicrobial recommendations
physician feedback on prescribing
improved communication between patient and HCP
commitment to stewardship
education