Antimicrobial stewardship Flashcards
Define AMS
Bundle of interventions to promote optimal use of antimicrobial therapy
Define empiric therapy
Initiated prior to culture and AST results
Define targeted therapy
Based on culture and AST results to have narrowest spectrum to cover pathogen
What is a good empiric option for broad spectrum gram negative cover in an ICU patient?
Carbapenem + amikacin
What is the duration of short course therapy for CAP
3-5d
What is the duration of short course therapy for nosocomial pneumonia
<8d
What is the duration of short course therapy for pyelonephritis
5-7d
What is the duration of short course therapy for intra-abdominal infection
4d
What is the duration of short course therapy for acute exacerbation of chronic bronchitis and COPD
<5d
What is the duration of short course therapy for acute bacterial sinusitis
5d
What is the duration of short course therapy for cellulitis
5-6d
What is the duration of short course therapy for chronic osteomyelitis
42d
What are methods of preventing AMR?
- Selective susceptibility reporting
- Clinical guidance in microbiology reports
- Access to local epidemiological data
- Access to institutional prescribing guidelines
- Antimicrobial prescribing policies
- Prospective prescribing audits
- AMS prescription charts
- Education, training and awareness
How can PCT be used to stop antibiotics?
Decline by 80%
<0.5
What are the disadvantages of PCT
Expensive
Less role in short term prescribing units
Give examples of process measures
- Guideline compliance
- De-escalation
- Documented indication for antimicrobial
Give examples of outcome measures
- Antimicrobial consumption
- AMR rates
- C.diff infection rates
Define prophylaxis
Antimicrobials given to prevent infection in specific indications eg pre-op
Define pre-emptive therapy
Antimicrobials against a pathogen in high risk patients prior to symptom development eg ganciclovir in transplant patients to prevent CMV infection
When is empiric antimicrobial therapy given?
- M&M assoc with delayed therapy is high
- Infectious syndromes where common pathogens known and lab diagnosis not indicated
What is an antibiogram?
Summary of
1. Pathogens
2. Particular specimen type
3. General susceptibility patterns
4. Specific location
5. Specific time period
What is the acceptable amount of susceptibility of an antimicrobial on an antibiogram?
> 80%
How long can you continue empiric therapy?
Reassessment at 72h
Maximum 5d
What is the definition of an HAI?
Acquired >96h in the unit (CDC)
> 48h (WHO)
How is C.diff rate reported?
Rate per 10 000 patient admission days
How is colistin resistant isolate rate reported?
Rate per 1000 patient admission days
What are the core strategies of AMS according to IDSA?
- Formulary restrictions and preauthorisation
- Prospective audit with intervention and feedback
- Multidisciplinary stewardship team
What are the supplemental strategies of AMS according to IDSA?
- Streamlining de-escalation of therapy
- Dose optimisation
- Parenteral to oral conversion
- Guidelines and clinical pathways
- AMS order forms
- Education
- Computerised decision support and surveillance
- Lab surveillance and feedback
- Combination therapies
- Antimicrobial cycling
