Antimicrobial Stewardship Flashcards
classify antimicrobial agents
- -Antibacterial – acts against a bacterium
- -Antimycobacterial – acts against a mycobacterium (e.g., M. tuberculosis that causes TB)
- -Antifungal – acts against a fungus (e.g., Candida or Aspergillus)
- -Antiviral – acts against a virus (e.g., HIV, influenza, HCV)
- -Antiparasitic – acts against a parasite (e.g., Plasmodium falciparum that causes malaria)
what is the role of antibiotics?
-Modern life could not survive without antibiotics
-protection for people with weakened immune systems – cancer patients, AIDS patients, transplant recipients, premature babies
-Surgical antibiotic prophylaxis
-
what is the frequency of antibiotic use?
- antimicrobials are commonly used medications
- 1/3 patients received antibiotics on any given day
- 1/20 residents received antibiotics on any given day
why do we prescribe antibiotics?
1) To treat the suspected infection
- -We don’t yet know the pathogen causing the infection = empiric treatment (“Start smart”)
- -We have identified the pathogen causing the infection = targeted treatment (“then focus”)
2) To prevent infection in situations associated with increased infection risk = prophylaxis
- -Medical prophylaxis – chemotherapy, transplant immunosuppression, post-splenectomy
- -Surgical antimicrobial prophylaxis – clean-implant, contaminated surgical procedures
3) For reasons other than an infection – e.g., anti-inflammatory properties (azithromycin), prokinetic properties (erythromycin)
what is the empirical antibiotic therapy?
Empiric antibiotic therapy refers to starting antibiotic therapy that covers the most probable causative organism(s) before the resistance pattern and/or causative organism are known.
what is the targeted antibiotic therapy
Antibiotic therapy is initiated after a culture and sensitivity report is available.
what are the principles of perioperative antibiotic therapy?
1) Perioperative antibiotic prophylaxis
- -Aim: To reduce the incidence of postoperative surgical site infections
- -Antibiotic of choice
a) First-line: intravenous cefazolin
b) In patients with beta-lactam allergy: clindamycin or vancomycin
c) Add intravenous metronidazole for:
- -Patient with small intestinal obstruction
- -Appendectomy
- -Colorectal surgery
metronidazole is used for perioperative antibiotic prophylaxis in what cases?
–Patient with small intestinal obstruction
–Appendectomy
–Colorectal surgery
increased risk o anaerobic infection. Remember metronidazole is usually used for anaerobic abdominal and pelvic infections, clindamycin for anaerobic thoracic infections (not always)
give examples of antibiotic that is used not to kill bacteria but to reduce inflammation
azithromycin in cystic fibrosis, used for years
give an example of an antibiotic that is used as prokinetic?
erythromycin in diabetic gastroparesis
what kind of impacts have antibiotic resistance?
1) Loss of productivity and income
- -Total GDP effect: $2.9 trillion by 2050
2) An additional $10000-40000 per infection
3) 700,000 deaths/year, Up to 9.5M / year by 2050
4) 33,000 deaths (> 100 airplanes / year)
how man deaths approximately every year are attributed to AMR (antimicrobial resistance)
10 million
what multidrug-resistant bacteria
A pathogen is termed as MDRGN when resistance is demonstrated to at least three antibiotic classes (see “Treatment of multiresistant pathogens” below).
Give examples of multidrug-resistant G+ bacteria
- Meticillin resistant Staphylococcus aureus (MRSA) (common cause ofhospitalacquired pneumonia)
- Vancomycin resistant enterococci (VRE) (common cause of intrabdominal infections,hospitalacquired urinary tract infections)
- Penicillin resistant Streptococcus pneumoniae
give examples of multidrug-resistant G- bacteria
- -Enterobacteriaceae that produce extended-spectrum beta-lactamases (ESBLs) and carbapenemases (CPE)
1) Klebsiella pneumoniae
2) E. coli
When was the last new antibiotic that was discovered?
oxazolidinones that target ribosomes (linezolid)
what are the consequences of AMR?
1) We get it wrong: Empiric treatment fails while we’re waiting to find out the causative pathogen
- -Delayed appropriate treatment of sepsis
- -Increased morbidity/duration of illness
- -Increased mortality
- -Increased healthcare costs – ICU, longer hospital stays, more expensive antimicrobials, complicated infections
2) We’re afraid of getting it wrong, so we use broader spectrum antimicrobials
- -Selection of even more resistant bacteria
3)Even the broader spectrum antimicrobials can’t be relied upon to work: Return to the pre-antibiotic era?
High mortality from previously treatable infectious diseases
–Elective surgery, chemotherapy, transplantation too risky
what is the antimicrobial stewardship?
- -Programmes and interventions that aim to optimize antimicrobial use
- -Originated within human healthcare
- -Increasingly applied in broader contexts “One Health”
what is the one-health approach?
Antibiotic resistance can arise in bacterial pathogens affecting humans, animals, and the environment. Strengthening detection and control of resistance requires the adoption of a “One-Health” approach that promotes the integration of public health and veterinary disease, food, and environmental surveillance. Improved detection can be achieved through appropriate data sharing, enhancement, expansion, and coordination of existing surveillance systems, and the creation of a regional laboratory network that provides a standardized platform for resistance testing and advanced capacity for genetic characterization of bacteria including whole-genome sequencing.
what are the principles of the One-Health approach?
1) Stresses that AMR is a growing European and global health problem in both humans and animals, leading to limited or poor options for the treatment whilst diminishing the quality of life and to important economic consequences in terms of augmenting healthcare costs and productivity losses
2) Recognizes that the development of AMR is accelerated by excessive and inappropriate use of antimicrobial agents which together with poor hygiene or poor infection control, creates favorable conditions for the development, spread, and persistence of resistant microorganisms in both humans and animals
3) Underlines the need of an active holistic risk-based approach based on One0helath perspective with the purpose of reducing the use of antimicrobials as much as possible and to maximize coordinated efforts between the human health sector and veterinary sector in the fight against AMR
what are the goals of antimicrobial stewardship?
1) To ensure the best clinical outcome for patients
2) To minimize unintended consequences of antimicrobial use:
- -Complications associated with vascular catheters placed to administer IV drugs
- -Adverse drug reactions – allergies, side effects
- -Clostridium difficile infection (CDI)
- -Emergence of antimicrobial resistance (AMR)
3)To minimize healthcare costs without compromising the quality of care
1 in 5 patients treated with antibiotics are harmed. True/False
True
what does antimicrobial stewardship mean?
1) Right antibiotic for the patient in front of you considering age, medical condition, antimicrobial resistance risks, pregnancy, etc
2) Right dose duration and route for the condition you are treating
3) Minimize adverse consequences
- -Cause the least amount of harm to that patient considering drug interactions, allergy, and toxicity
- -Least harm to future patients by increasing antimicrobial resistance
4) Bacterial infections only - Do not prescribe for viral infections
5) Infection Prevention
- -Promote the use of immunization to minimize infections
- -Practice good infection control to minimize the spread of infections/AMR
do viral infections require to be treated with antibiotics?
Bacterial infections only - Do not prescribe for viral infections, one of the important reasons for emerging antibiotic resistance, the other one is the use of antibiotics in agriculture
