Antimicrobial stewardship

Question 1

Deveopment of Antimicrobial resistance

Answer 1

• Antimicrobial products used to kill or significantly slow growth of disease and microbes
• Selective pressures due to evolution mechanis that allows microbes to resist antimicrobial activity
• Resistant microbes are able to survive antimicrobial treatment
• AMR pass resistant genes via vertical and horizontal

Question 2

Over prescribing of antibiotics

Answer 2

• Only for vital self limiting conditions taken as self care inappropriate dosing

Question 2

Patient non-compliance

Answer 2

Patients not completing the course or
unable to afford the full course. Not taking as prescribed

Question 2

Poor quality antbiotics

Answer 2

• Expired substandard medicines

Question 3

Use of antibiotics in domestic animals

Answer 3

• Spread thrugh water and food systems
• Increase pressure and antimicrobial resistance

Question 4

Poor hygiene and sanitation as a cause of resistance

Answer 4

• Poorly filtered waste water can lead to the spread of resistant microbes and hand hygine

Question 5

Lack of new antibiotics being developed causing resistance

Answer 5

• Prescribing pressures
  on antibiotics that we have access to, increasing use and
  exposure

Question 6

Consequences of Antimicrobial Resistance at Patient Level

Answer 6

• Delay in appropriate antibiotic therapy
• Increase hospital length and stay
• Alternative drugs required cause adverse effects and cost implications

Question 7

Antimicrobial Stewardship

Answer 7

• Promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness

Question 8

Prudent prescribing

Answer 8

• Not to prescribe as few antibiotics as
  possible but to identify that small
  group of patients who really need
  antibiotic treatment

Question 9

AMR guidance

Start Smart…

Answer 9

• Do not start antibiotics if clinical evidence for bacterial infection not present
• Allergy history taken and compliance to local antimicrobial guidance
• include review and stop date

Question 10

AMR guidance

…Then focus

Answer 10

• Clinical review and decision in 48-72hrs
• Clinical review check microbiology
• Stop, change from IV to oral, change or comtinue

Question 11

Establishing presence of bacterial infection

Answer 11

• Severity assessment tools EVERPAIN/CENTO to diagnose strep thoat infections
• Urine dip sticks - not reliable for cathader and old people
• CRP for acute cough/IECOPD
• Sore throat test and treat services with antigen testing

Question 12

Alternative prescribing strategies of antibiotics

Answer 12

• Back up prescribing - not dispensed immediately if symptoms worsen
• Reassue
• Reasons for mot use
• Relief use paracetamol
• Reinforce keyt message and rescue by safety netting

Question 13

Empirical Antibiotics

Answer 13

• When pathogen and antibiotics sensitivity is uncertain
• Local pathogen epidemiology data
• Local antibiotic sensitivity data

Question 14

Narrow spectrum antibiotics

Answer 14

• Specific and are only active
  against certain groups or strain of bacteria

Question 15

Broad-spectrum antibiotics

Answer 15

• Inhibit wide range of bacterial infections more likely to drive resistance cause C.difficile infection

Question 16

WHO AWaRe Classification: Access, Watch and Reserve

Answer 16

• Impact of each antibiotics and emphasis of importance of appropriate usage

Question 17

Access

Answer 17

• First/second choice offer best theraputic value while
  minimizing the potential
  for resistance
• Amoxicillin, doxycycline,
  metronidazole

Question 18

Watch

Answer 18

• For specific limited number of infective syndromes
• More prone to antibiotic resistance priority for stewardship program
• Cefuroxime, Ciprofloxacin,
  Meropenem

Question 19

Reserve

Answer 19

• Last resort very selective for life threatening
• Closely monitored and prioritised by targets of stewardship
• Colistin,
  Ceftazidime/Avibactam,
  Linezolid

Question 20

Antimicrobial guidelines

Answer 20

• Clinical diagnosis - Evidence of infection and severity assessment
• Recommend non-antimicrobial treatment
• When to contact infectious disease consultant
• Oral switch during IV therapy

Question 21

Allergy status

Answer 21

• Allergy vs ADR take accurate drug history de label program
• Uneccessary avoidance of penicillin and other beta-lactam antibacterials
• Increased use of of broad spectrum
• poor clinical outcomes

Question 22

Microbiology testing

Answer 22

• Rapid organism identification improved
  patient outcomes
• Lead to inappropriate treatment if
  wider clinical context not taken into
  consideration

Question 23

Infection colonisation and carriage

Answer 23

• Invasion of the body or a body part by a pathogenic organism - harmful effects on body tissue
• Tissue invasion or damage
• Carring pathogen

Question 24

IV to Oral Switch

Answer 24

• IV therapy initially can be switched to
  oral after 24-48 hours provided that
  they are improving clinically
• Not all infections and patients can undergo IV to oral switch

Question 25

IV to oral switch checklist

Answer 25

• Patient infection that can be effectively treated with oral antibiotics
• No concern about oral absorption
• Patient showing siggnas of improvement

Question 26

Benifits of IV to PO

Answer 26

• Removes lines quicker
• Reduce nursing workload
• Increase patient satisfaction
• Facilitate earlier discharge
• Decrease costs
• More sustainable as less plastics used
• narrow spectrum agent - less use of broad

Question 27

Reasons for inapropriate prescribing

Answer 27

• Lack of awareness on guidelines
• Due to time constraint
• Decision fatigue due to repeat prescribing
• Uncertain diagnosis viral quite similar
• Assume other prescribers are the problem
• Patient satisfaction pressue