Antimicrobial stewardship

Question 1

Define AMS

Answer 1

Bundle of interventions to promote optimal use of antimicrobial therapy

Question 2

Define empiric therapy

Answer 2

Initiated prior to culture and AST results

Question 3

Define targeted therapy

Answer 3

Based on culture and AST results to have narrowest spectrum to cover pathogen

Question 4

What is a good empiric option for broad spectrum gram negative cover in an ICU patient?

Answer 4

Carbapenem + amikacin

Question 5

What is the duration of short course therapy for CAP

Answer 5

3-5d

Question 6

What is the duration of short course therapy for nosocomial pneumonia

Answer 6

<8d

Question 7

What is the duration of short course therapy for pyelonephritis

Answer 7

5-7d

Question 8

What is the duration of short course therapy for intra-abdominal infection

Answer 8

4d

Question 9

What is the duration of short course therapy for acute exacerbation of chronic bronchitis and COPD

Answer 9

<5d

Question 10

What is the duration of short course therapy for acute bacterial sinusitis

Answer 10

5d

Question 11

What is the duration of short course therapy for cellulitis

Answer 11

5-6d

Question 12

What is the duration of short course therapy for chronic osteomyelitis

Answer 12

42d

Question 13

What are methods of preventing AMR?

Answer 13

1. Selective susceptibility reporting
2. Clinical guidance in microbiology reports
3. Access to local epidemiological data
4. Access to institutional prescribing guidelines
5. Antimicrobial prescribing policies
6. Prospective prescribing audits
7. AMS prescription charts
8. Education, training and awareness

Question 14

How can PCT be used to stop antibiotics?

Answer 14

Decline by 80%
<0.5

Question 15

What are the disadvantages of PCT

Answer 15

Expensive
Less role in short term prescribing units

Question 16

Give examples of process measures

Answer 16

1. Guideline compliance
2. De-escalation
3. Documented indication for antimicrobial

Question 17

Give examples of outcome measures

Answer 17

1. Antimicrobial consumption
2. AMR rates
3. C.diff infection rates

Question 18

Define prophylaxis

Answer 18

Antimicrobials given to prevent infection in specific indications eg pre-op

Question 19

Define pre-emptive therapy

Answer 19

Antimicrobials against a pathogen in high risk patients prior to symptom development eg ganciclovir in transplant patients to prevent CMV infection

Question 20

When is empiric antimicrobial therapy given?

Answer 20

1. M&M assoc with delayed therapy is high
2. Infectious syndromes where common pathogens known and lab diagnosis not indicated

Question 21

What is an antibiogram?

Answer 21

Summary of
1. Pathogens
2. Particular specimen type
3. General susceptibility patterns
4. Specific location
5. Specific time period

Question 22

What is the acceptable amount of susceptibility of an antimicrobial on an antibiogram?

Answer 22

> 80%

Question 23

How long can you continue empiric therapy?

Answer 23

Reassessment at 72h
Maximum 5d

Question 24

What is the definition of an HAI?

Answer 24

Acquired >96h in the unit (CDC)
> 48h (WHO)

Question 25

How is C.diff rate reported?

Answer 25

Rate per 10 000 patient admission days

Question 26

How is colistin resistant isolate rate reported?

Answer 26

Rate per 1000 patient admission days

Question 27

What are the core strategies of AMS according to IDSA?

Answer 27

1. Formulary restrictions and preauthorisation 2. Prospective audit with intervention and feedback 3. Multidisciplinary stewardship team

Question 28

What are the supplemental strategies of AMS according to IDSA?

Answer 28

1. Streamlining de-escalation of therapy 2. Dose optimisation 3. Parenteral to oral conversion 4. Guidelines and clinical pathways 5. AMS order forms 6. Education 7. Computerised decision support and surveillance 8. Lab surveillance and feedback 9. Combination therapies 10. Antimicrobial cycling