Antimicrobial stewardship

Question 1

the 3 approaches for AMS tend to fall in what 3 categories

Answer 1

educational
social
technological

Question 2

list some educational strategies towards ams

Answer 2

mandatory training
guidelines and protocols
prescriber and nurse training and feedback
patient education

Question 3

list some social strategies towards towards ams

Answer 3

staff and committees
environment
opportunities for behaviour change
reinforcement

Question 4

list some technological strategies towards ams

Answer 4

electronic prescribing
clinical decision support
phone applications
antibiograms
access to data for surveillance

Question 5

why is adherence to ams strategies and guidelines essential

Answer 5

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

Question 6

are the following LOCAL signs of infection likely to be patient or practitioner perceived:

erythema
pain
swelling
heat
oedema
discharge

Answer 6

practitioner

Question 7

are the following SYSTEMIC signs of infection likely to be practitioner or patient perceived :

pyrexia
hypothermia
tachycardia
raised wcc and crp
increased serum lactate

Answer 7

practitioner

Question 8

are the following LOCAL symptoms of infection likely to be patient or practitioner reported

pain
sweating
chills

Answer 8

patient

Question 9

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

Answer 9

patient

Question 10

what investigations would you do if you suspect a px has a infection

Answer 10

vital signs NEWS2
blood tests
imaging
culture and sensitivities

Question 11

what blood tests would you do on suspected infection?

Answer 11

FBC
U+Es

Question 12

list some different things you can obtain samples from for cultures and sensitivities

Answer 12

CSF from lumber puncture, urine, sputum, blood

Question 13

what score can be used to determine vital signs for deterioration and serious illness

Answer 13

NEWS2

Question 14

what score can be used to predict mortality from CAP (community acquired pneumonia)

Answer 14

CURB-65

Question 15

what score can be used for the likelihood of streptococcal throat infection that may benefit from antibiotics

Answer 15

feverpain score and centor criteria

Question 16

what is the SIRS tool used for

Answer 16

sepsis

Question 17

aside from the sirs tool what else can be used to identify sepsis red and amber flags

Answer 17

screening and action tool for sepsis

Question 18

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

Answer 18

evidence of bacterial infection
severity of infection
probable differential diagnosis
previous infection history
documented resistance
drug allergies and contraindications
use up to date guidelines

Question 19

what can be used for evidence of bacterial infections

Answer 19

signs
symptoms
investigations

Question 20

signs symptoms and scores can all be used to determine the x of an infection

Answer 20

severity

Question 21

what is meant by empiric treatment

Answer 21

treatment based on differential diagnosis and likely but unknown causative organism

Question 22

what needs to happen in order to move from empiric to directed treatment

Answer 22

samples need to taken for the suspected infection so cultures and sensitivities can be assessed

Question 23

why is it important that clinical assessment is thoroughly documented throughout

Answer 23

so any change in condition can be effectively compared

Question 24

how can we confirm that empiric treatment selection is appropriate and treatment can continue

Answer 24

improvement in signs and symptoms and cultures confirm sensitivity

Question 25

what would prompt a clinician to decide that empiric treatment selection is not appropriate for the infection and requires change

Answer 25

cultures confirm resistance and deterioration in signs and symptoms or no improvement observed

Question 26

the focusing aspect of management should take place within x hrs but ideally within 24-48 hrs

Answer 26

24-72

Question 27

The focusing of antimicrobial treatment aims to do one of three things:

Answer 27

continue
change
stop

Question 28

what 3 things to check if looking to continue empirical Tx?

Answer 28

any adverse effects?
review route - can you switch IV-oral if not can px become outpatient Tx
check duration remaining is approp

Question 29

what to check when changing empirical tx?

Answer 29

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

Question 30

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

Answer 30

true

Question 31

2 places/ people that are key to consult/ involve in the decision making process

Answer 31

guidelines and microbiology

Question 32

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

Answer 32

4

Question 33

UTIs in uncatherterised patients are predominantly caused by which bacteria?

Answer 33

caused by bacteria from GIT entering urinary tract commonly klebsiella pneumoniae

Question 34

which bacteria is a more common cause for uncatherised patients in hospital

Answer 34

pseudomonas aeruginosa

Question 35

in people who are catherised what bacterias are more prominent and therefore require different empiric uti antibiotic regimen until cultures and sensitivities are available

Answer 35

staph epidermidis and enterococcus faecalis

Question 36

which bacterias are the most prominent on the skin and therefore are the cause of most skin infections

Answer 36

staphylococcus aureus and staphylococcus epidermidus

Question 37

Which antibiotics has been MOST associated with cases of C. difficile infection?

Answer 37

quinolones and cephalosporins