Antimicrobial Stewardship Flashcards
MRSA is resistant to
Methicillin resistant staph aureaus
methicillin, amoxicillin, penicillin, oxacillin
penicillins
cephlasporins
ESBL is resistant to
extended-spectrum beta-lactamase-producing enterobacteriaceae
- penicillin
- broad spec cephalosporins
- monobactams
CPE is resistant to
carbapenemase-producing enterobacteriaceae
- carbapenems
- penicillins
SSTF means
start smart and then focus
SMART means…
Do not start ABX in the absence of clinical evidence of a bacterial infection
- allergy
- review date
- cultures
- give in 1 hour for sepsis
- document indication
- comply with local guidance
then focus means….
At 48 hours ensure than a clinical review takes places and make and document and antimicrobial decision.
- stop
- IV to oral
- narrow spectrum agent
- continue current therapy and review in 72 hours
- OPAT?
Fluoroquinolone’s and quinolones
Should not be used as what we use them for we have other classes of ABX that can be used.
However this includes ciprofloxacin and we use that for catheter associated UTI?
they cause long lasting muscle/tendon/nervous system (confusion, pins & needles, tiredness etc) damage
Mandatory surveillance for
MRSA MSSA C.diff E.coli VRE.GRE Surgical site infections
ABX most likely to cause c.diff
clindamycin
Others that have a high risk:
fluroquinolones, cephalosporins, aztreonam, carbapenems
Risk factors for developing C.diff
multiple ABX use long course of ABX hospital admission age poor immune system
what is c.diff?
What symptoms does it cause?
How to we confirm a patient has it?
A spor producing gram positive anaerobic bacterium
colitis, water diarrhoea, dehydration, abdominal tenderness, fever
Two tests together - GDH and A/B. Positive from both is 91.4% likely a patient has it. A single positive test is not very strong in evidence.
C.diff is graded in severity
Mild - no raised WCC. stools <3 on chart
Mod - WCC raised <15 and stools 3-5 a day
Severe - Temp >38.5. WCC >14. acute rise in createnin >50% above baselines, severe colitis
Life threatening - hypotension, ileum, toxic megacolon, CTE evidence of severe disease
Treatment of C.diff
Metronidazole for mild - mod. Vancomycin has poor oral bioavailability and the IV does not penetrate the gut mucosa therefore is not a substitute. 400mg TDS for 10-14 days.
Fidaxomycin - cost effective in severe disease, due to the high risk of reoccurrence. 200mg BD for 10/7
What other medicines can we stop that can increase the risk of C.diff
PPI’s, H2 receptor antagonists.
Acid suppressors.
loperamide stuff like that - can reduce the clearance of c.diff from the intestine and precipitate toxic megacolon
laxatives
risk of AKI due to dehydration - NSAIDs, Ace inhibitors, diuretics.
Is alcohol gel effective against the spores of c.diff?
No
