Antimicrobial Stewardship

Question 1

What is antimicrobial stewardship?

Answer 1

main strategy for preventing antimicrobial resistance

Question 2

Antimicrobials

Answer 2

Antibiotics
Antivirals
Antiparasitics
Antifungals
antimicrobial drugs only work against one type of organism

Question 3

Antimicrobial Resistance

Answer 3

When microorganisms change/mutate over time and get to a point where they no longer repond to medicines previously used to treat them.

Question 4

AMR - Antimicrobial Resistance

Answer 4

Resistance of a microorganism to an antimicrobial drug that was originally effective

Question 5

How does AMR happen?

Answer 5

1 - Lots of germs, some are drug resistant. 2 - Antibiotics kill pathogenic bacteria and s good bacteria protecting the body from infection. 3 - drug resistant bacteria now allowed to grow and take over. 4- Some bacteria give their drug-resistance to other bacteria causing more issue.

Question 6

How does AMR spread?

Answer 6

Animals get antibiotics and develop resistant bacteria gut - drug-resistant bacteria on meat spreads to humans if cooked improperly. Fertiliser/water containing animal feces/drug-resistant bacteria used on food crops - remains on crops which then remains in the human gut.
- Drug-resistant bacteria in gut can spread to community/hopsitals/other patients/healthcare providers.
Antibiotics only used to treat infections.
can sp in theit gut can spread it in their communit/hospitals to healthcare providers or patients.
Antibiotics should only be used to treat infections.

Question 7

Why are there less new antibiotics

Answer 7

Antibiotic pipeline has dried up, under investing in AMR research

Question 8

Examples of problematic AMR bacteria.

Answer 8

MDR and XDR Mycobacterium tuberculosis. Methicillin resistant Staphylococcus aureus (MRSA) - and vancomycin resistant VRSA. Carbapenem resistant Enterobacteriaceae (CRE).KPC Klebsiella pneumoniae
NDM-1 E. coli. In 2015, mcr-1 gene for colistin resistance discovered on plasmid in E. coli

Question 9

How is AMR tackled?

Answer 9

Global & National Action Plans, New Treatments & Vaccine, Infection Prevention & Control, Antimicrobial Stewardship, Awareness Raising & Training, One Health approaches, Surveillance

Question 10

Antimicrobial Stewardship

Answer 10

Responsible use of antimicrobials to preserve future effectiveness. Set of actions to maximise benefits of antimicrobials while reducing AMR, side effects and other adverse events (HCAI development)

Question 11

Antimicrobial Sterwardship - What are the Risks vs Benefits of using antimicrobials?

Answer 11

Consider if use needed e.g will it speed up recovery or prevent invasive complications? Need to decide based against risks :AMR to patient and population, side effects of antimicrobial drugs including micro biotoxicity

Question 12

Prescription and dispensing of antimicrobials

Answer 12

Must be in accordance with up-to-date clinical guidelines: correct drug ,correct dose, correct duration (shortest effective course), most appropriate route of administration (e.g. switch from i.v. to oral ASAP)

Question 13

Antimicrobial Alternatives

Answer 13

self-care :over-the-counter preparations (e.g. antipyretics (drug to reduce fever)). back-up (delayed) prescribing e.g “only use this prescription if symptom X… or if no better after X days…”, other non-pharmaceutical interventions - e.g. draining site of infection

Question 14

Infection prevention & control

Answer 14

Aims to minimise the number of infections and spread of AMR organisms.
- sanitation & hygiene
- surveillance & epidemiology
- vaccination & other public health measures

Question 15

How can a patient help with Antimicrobial Stewardship?

Answer 15

always follow the advice of a prescriber

• never seek antimicrobials without prescription & medical advice

Question 16

How can a future bioscientist/ healthcare professional help with Antimicrobial Stewardship?

Answer 16

• get involved in AMR research
• support AMS efforts in your workplace
• talk with friends, family, colleagues, patients…
• Become an Antibiotic Guardian at
  https://antibioticguardian.com/

Question 17

Role of the clinical micro lab in AMS: Guiding appropriate treatment of the patient

Answer 17

• Identify causative organism
• Antimicrobial susceptibility testing
• Offer advice to clinicians re: best treatment options for patient

Question 18

Role of the clinical micro lab in AMS: Generate, collate & report on data

Answer 18

• generates data such as identitidy of the species/strain/type of organism causing the infection and the AMR rate for that type of infection.
  Data used to inform and update clinical prescribing guidelines – can be lifesaving incases where patients may need immediate treatment (cant wait for culture/AST testing)

Question 19

Role of the clinical micro lab in AMS: Supporting efforts to prevent infections

Answer 19

• Diagnosis of infection in one patient => NPIs can be put in place to prevent it passing to others (e.g. HIV, MRSA, TB…)
• Identification and investigation of AMR outbreaks on hospital wards