Antimicrobial Stewardship Flashcards
What is antimicrobial stewardship?
“Coordinated interventions designed to improve and measure the appropriate use of antibiotic agents by promoting the selection of the optimal drug regimen including dosing, duration of therapy, and route of administration”
What are the goals of antimicrobial stewardship? (4)
-Optimize clinical outcomes related to antimicrobial use -Minimize toxicity and other adverse events
-Reduce healthcare costs for infections
-Limit the selection for antimicrobial resistant strains
What is a the pharmacist’s role in an antimicrobial stewardship program?
-To promote the judicious use of antibiotics
Antimicrobial Threats (Resistant Pathogen)
-Carbopenem-resistant Acinetobacter
-Carbapenem-resistant Enterobacterales (Klebsiella, Enterobacter)
-ESBL-producing Enterobacterales (Klebsiella, Enterobacter)
-Vancomycin-resistant Enterococcus (VRE)
-Multidrug-resistant Pseudomonas aeruginosa
-Methicillin-resistant Staphylococcus aureus (MRSA)
Why Do We Need Antimicrobial Stewardship?
-Antibiotic overuse and misuse
—Unnecessary use: Asymptomatic bacteriuria, respiratory viruses, etc. -Wrong dose
-Wrong drug
-Excessive duration of therapy
It is estimated that _________ __________ _________ of the antibiotics prescribed to children in the outpatient setting are unnecessary
More than half
Antibiotics cause _____ in _____ ER visits for adverse drug events
1 in 5
What are the problems with antimicrobial prescribing?
-Low threshold for prescribing antimicrobials —Perceived as non-toxic
—-Major problem for outpatient settings —-Antibiotics “just in case”
—True infection vs. colonization
—-Provider unfamiliarity with antibiotic principles
-Broad-spectrum empiric agents started but lack of appropriate de-escalation
—-Use of negative cultures
-Use of suboptimal regimens
—Agent selection, dose, and route can be optimized
—-Requires educational interventions
MRSA/Gram Positive Agents
-Vancomycin (IV)
-Linezolid (IV)
-Daptomycin (IV)
-Clindamycin (oral)
-TMP/SMX (Bactrim) (oral)
-Doxycycline (oral)
Pseudomonas/Gram Negative Agents
-Piperacillin/tazobactam (IV)
-Cefepime (IV)
-Ceftazidime +/- avibactam (IV)
-Ceftolozane/tazobactam (IV)
-Carbapenems except Ertapenem (IV)
-Levofloxacin, Ciprofloxacin, Delafloxacin (oral)
What are the patient consequences of inappropriate antimicrobial therapy?
- Inadequate treatment
- Adverse effects
- Allergic reactions
- Superinfections
- Antimicrobial resistance
- Selection of problematic pathogens (C. difficile)
What are the societal consequences of inappropriate antimicrobial therapy?
-Antimicrobial resistance
—-Aka “collateral damage”
-Increased healthcare costs
What are the benefits of antimicrobial stewardship? (5)
-Improved patient outcomes
-Decreased adverse events
—-C. difficile-associated diarrhea
-Antibiotic susceptibility
—-Minimize development of antibiotic resistance
-Resource optimization
-Reduce healthcare costs without sacrificing quality of care
What are the 7 core elements of hospital Antibiotic Stewardship Programs? (Not in order)
1.) Hospital Leadership Commitment
—-Dedicate necessary human, financial and information technology resources
2.) Accountability
—-Appoint a leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes
3.) Pharmacy Expertise
—-Appoint a pharmacist, ideally as the co-leader of the stewardship program, to lead implementation efforts to improve
antibiotic use
4.) Action
—-Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use
5.) Tracking
—-Monitor antibiotic prescribing, impact of interventions, and other important outcomes like C. difficile infection and resistance patterns
6.) Reporting
—-Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership
7.) Education
—-Educate prescribers, pharmacists, and nurses about adverse reactions from antibiotics, antibiotic resistance and optimal prescribing
What are the pharmacy-based stewardship interventions?
-Documentation of indications
-IV to PO switch
-Dose adjustment/optimization
-Time-sensitive automatic stop orders
-Penicillin allergy assessment
-Detection/prevention antibiotic-related drug-drug interactions
-Formulary restriction & preauthorization
