Antimicrobial Stewardship Flashcards
IDSA/SHEA Stewardship Categories
Abx Interventions (before) ABx Optimization (during) Metrics (after) Collaboration with Micro (way after) Special Populations
What falls under the IDSA/SHEA Stewarship “Intervention” Category
Preauthorization or Prospective Audit (strong)
Reduce use of C. diff causing ABx (strong)
Didactic Education
Institutional Clinical Practice Guidelines
Syndrome-specific interventions
Prescriber-led review of abx
Abx cycling
What falls under the IDSA/SHEA Stewarship “Optimization” Category
PK monitoring of aminoglycosides (Strong)
IV-to-PO switch (Strong)
Promote appropriate duration of therapy (Strong)
PK monitoring of vancomycin (Weak)
Alternative dosing strategies based on PK principles (Weak)
Beta-lactam allergy assessment (Weak)
What falls under the IDSA/SHEA Stewarship “Collaboration with Lab/Micro” Category
Develop antibiogram (Strong)
Selective or cascade reporting of susceptibility results (Weak)
Rapid viral testing to reduce inappropriate antibiotics (Weak)
Rapid diagnostic testing of blood (Weak)
Procalcitonin testing in ICU patients (Weak)
Fungal diagnostics in hematologic patients (Weak)
CDC Core Elements of a Stewarship Program
Leadership Commitment
Accountability
Pharmacy Expertise
Action
-Updated core elements recommend priority
interventions:
o Prospective audit with feedback
o Prior authorization
Tracking
Reporting
EducationWhat organization provides recommendations for developing antibiograms?
CLSI - Clinical Laboratory Standards Institute
The M-39 document.
Which isolates should be used to construct an antibiogram?
First isolate per patient per year.
How many isolates should you have before including on antibiogram?
30
Let’s say that you have 34 isolates of Staph Epi that you tested for Zyvox sensitivity, out of 270 total Staph Epi isolates. Should you include it on the antibiogram?
No. Only include for agents that you routinely tested. Selction bias can skew results. Maybe those 30 isolates were only tested after seeing that they were resistant to other therapies.
What are the 6 rules for developing antibiograms?
- First isolate per patient per year
- Only include org with at least 30 isolates
- Only include abx that are routinely tested
- Report percent susceptible
- Use confidence intervals.
- Data should be shared with prescribers
What are the limitations of CLSI antibiogram recs?
- Unable to detect differences between units
- Unable to observe differences in source (urine etc)
- Unable to assess combination therapy (need dual axis for that)
- Unable to track development of resistance (only using first isolate per patient per year)
What are the PACCARB Goals for 2020?
Reduce:
- CRE 60%
- C diff and MRSA 50%
- Hospital acquired MDR Pseudomonas 35%
- MDR non-typhoidal Salmonella 25%
- Abx resistant invasive pneumococcal disease among patients < 5 or > 65 by 25%
- MDR TB infections 15%
What are the 3 categories of the “Action” element of CDC’s Core elements of an antimicrobial stewardship program?
These are all related to IDSA “Interventions” category
- Broad Interventions: Abx time-out, pre-auth, prospective audit.
- Pharmacy Driven Interventions: IV-PO switch, dose adjustment, dose optimization, automatic stop, Drug drug interactions and duplicate therapy
- Syndrome Specific Interventions:
What infections does the CDC recommend focusing on for syndrome specific interventions (Core element>action>syndrome-specific)
SSTI’s, UTI’s, and Respiratory Infections
What are some metrics IDSA recommends following?
Antimicrobial DOT
Antimicrobial expense (administration data)
Syndrome-specific goals
