Antimicrobial stewardship Flashcards
the 3 approaches for AMS tend to fall in what 3 categories
educational
social
technological
list some educational strategies towards ams
mandatory training
guidelines and protocols
prescriber and nurse training and feedback
patient education
list some social strategies towards towards ams
staff and committees
environment
opportunities for behaviour change
reinforcement
list some technological strategies towards ams
electronic prescribing
clinical decision support
phone applications
antibiograms
access to data for surveillance
why is adherence to ams strategies and guidelines essential
no new promising antimicrobials in the pipeline
Multi-drug resistant gram negatives have become a major threat to healthcare
Healthcare associated infections are a problem
are the following LOCAL signs of infection likely to be patient or practitioner perceived:
erythema
pain
swelling
heat
oedema
discharge
practitioner
are the following SYSTEMIC signs of infection likely to be practitioner or patient perceived :
pyrexia
hypothermia
tachycardia
raised wcc and crp
increased serum lactate
practitioner
are the following LOCAL symptoms of infection likely to be patient or practitioner reported
pain
sweating
chills
patient
are the following SYSTEMIC symptoms of infection likely to be patient or practitioner perceived
cough
sweating
chills
pain
sore throat
loss of appetite
tired
confused
dizzy
sob
patient
what investigations would you do if you suspect a px has a infection
vital signs NEWS2
blood tests
imaging
culture and sensitivities
what blood tests would you do on suspected infection?
FBC
U+Es
list some different things you can obtain samples from for cultures and sensitivities
CSF from lumber puncture, urine, sputum, blood
what score can be used to determine vital signs for deterioration and serious illness
NEWS2
what score can be used to predict mortality from CAP (community acquired pneumonia)
CURB-65
what score can be used for the likelihood of streptococcal throat infection that may benefit from antibiotics
feverpain score and centor criteria
what is the SIRS tool used for
sepsis
aside from the sirs tool what else can be used to identify sepsis red and amber flags
screening and action tool for sepsis
what steps are necessary to follow a ‘smart’ approach to the initiation of antimicrobials to ensure patient safety and reduce the inappropriate use of antimicrobials and resistance
evidence of bacterial infection
severity of infection
probable differential diagnosis
previous infection history
documented resistance
drug allergies and contraindications
use up to date guidelines
what can be used for evidence of bacterial infections
signs
symptoms
investigations
signs symptoms and scores can all be used to determine the x of an infection
severity
what is meant by empiric treatment
treatment based on differential diagnosis and likely but unknown causative organism
what needs to happen in order to move from empiric to directed treatment
samples need to taken for the suspected infection so cultures and sensitivities can be assessed
why is it important that clinical assessment is thoroughly documented throughout
so any change in condition can be effectively compared
how can we confirm that empiric treatment selection is appropriate and treatment can continue
improvement in signs and symptoms and cultures confirm sensitivity
what would prompt a clinician to decide that empiric treatment selection is not appropriate for the infection and requires change
cultures confirm resistance and deterioration in signs and symptoms or no improvement observed
the focusing aspect of management should take place within x hrs but ideally within 24-48 hrs
24-72
The focusing of antimicrobial treatment aims to do one of three things:
continue
change
stop
what 3 things to check if looking to continue empirical Tx?
any adverse effects?
review route - can you switch IV-oral if not can px become outpatient Tx
check duration remaining is approp
what to check when changing empirical tx?
cultures for sensitivity and initiate the ‘start’ process again to ensure safe and optimal prescribing:
- px history for allergies and contraindications
- Assess signs and symptoms
-Check the guidelines
true or false, the direction of treatment needs to be clearly outlined in the medical notes and communicated to the patient and it is important to assess any amendment to the existing treatment has been implemented on the prescription
true
2 places/ people that are key to consult/ involve in the decision making process
guidelines and microbiology
a feverpain of x or above is associated with a 62-65% isolation of streptococcus and therefore antibiotics could be considered if the pt is systemically unwell
4
UTIs in uncatherterised patients are predominantly caused by which bacteria?
caused by bacteria from GIT entering urinary tract commonly klebsiella pneumoniae
which bacteria is a more common cause for uncatherised patients in hospital
pseudomonas aeruginosa
in people who are catherised what bacterias are more prominent and therefore require different empiric uti antibiotic regimen until cultures and sensitivities are available
staph epidermidis and enterococcus faecalis
which bacterias are the most prominent on the skin and therefore are the cause of most skin infections
staphylococcus aureus and staphylococcus epidermidus
Which antibiotics has been MOST associated with cases of C. difficile infection?
quinolones and cephalosporins
