Antimicrobial Stewardship Flashcards
What is antimicrobial stewardship? (4)
Appropriate use of antimicrobials for optimum clinical outcome.
Minimise toxicity and adverse effects
Reduce costs
Reduce resistance
What other two things can you do to reduce infection in the first place?
Infection prevention controls
Environment decontamination
Why do you need antimicrobial stewardship? What is one downside of it?
Increased resistance
Antibiotic discovery void
Increased costs to healthcare
Better patient outcomes needed
Risk of readmission if antibiotic course not long enough
Name 3 ways you can measure outcomes of antibiotic stewardship
Look at:
Patient outcomes
C diff infection rate
Emergence of resistance
Has antibiotic resistance always been around? Why? Does this mean resistance is inevitable?
Yes because there is intrinsic resistance where some bacteria are naturally resistant to certain antibiotics. Yes - so need to look at preventing bacterial spread in first place.
What are 3 consequences of antimicrobial failure?
Treatment failure
Cost
Prophylaxis failure - e.g. pre surgery
Define multi-drug resistant, extensively drug resistant, pan-drug resistant
Multi - non susceptibility to at least 1 agent in 3 or more antimicrobial categories (least worse of the 3)
Extensively - non susceptibility to at least one agent in all but two or fewer antimicrobial categories
Pan - Non susceptibility to all (worst)
What evidence do we have that antibacterials cause resistance? (3) Which of these is the best evidence?
1) Lab studies
2) Ecological studies - shows level of antibacterial use in a population compared to levels of resistance
3) Individual data- if a person with previous use is now resistant to that antibacterial.
Number 3 best evidence
3 elements of an antimicrobial stewardship programme?
Multidisciplinary teams working together
Surveillance - process and outcome measures
Interventions - persuasive restrictive structural
Give examples of persuasive, restrictive and structural interventions
Persuasive - educate, remind, audit, feedback on use of antibiotic etc
Restrictive - microbiologists restricting susceptibility reporting (e.g. they give less options for antibiotic you could use for a particular infection), prior authorisation - asking permission to use certain antibiotic
Structural - computerised records, rapid lab tests, quality monitoring
In surveillance of a stewardship programme give examples of process measures (3) and outcome measures (3)?
Process measures - comparing use of antibiotics/class chosen/appropriateness etc (adherence to guidelines) compared to other institutions, and overtime in the same institution.
Outcome measures - patient outcomes, emergence of resistance, c.diff infection rates
What three things do you need for successful stewardship?
Long term resources
Hospital leadership - to challenge and change
Integration into patient safety/quality of care processes
Which of the three interventions restrictive, structural or persuasive gives the quickest results?
Restrictive - block usage of certain antibiotics immediately etc.
Give an example of an infection that has reduced with stewardship in recent times?
C.diff.
Do short or long term antibiotic treatments promote resistance and why? What is the issue with short treatments?
Long term ones contrary to what you might think - as leaves only resistant bacteria. Hence you can give prophylactic 1 dose antibiotics pre surgery as doesn’t promote resistance. Short treatment issue is treatment failure.
