Antimicrobial Stewardship - Block 1 Flashcards
What is AS?
Optimal selection, doage, and duration of ABX tx for best clinical outcome to minimie toxicity and resistance
What are the goals of AS?
- Patient recieves appropriate ABX
- Prevent overuse, misuse, and abuse
- Minimize the development of resistance
What are the steps for optimal ABX therapy?
Right:
1. Drug
2. Dose
3. De-escalation
4. Duration
What is de-escalation?
- Broad -> narrow
- Combo -> mono
- Stopping ABX when its no longer needed
What is overuse?
Providers use ABX when not necessary
What is misuse?
Failure to ajust ABX based on culture results
What is abuse?
Use of particular ABX preferentially over others (excess dose)
What are the CDC core elements?
Leadership commitment
Accountability
Drug expertise
Reporting
Action
Tracking
Education
What are AS strategies?
- Formulaties and PA
- Prospective review and feedback
- Rapid diagnostic tests
- Order sets and algorithms
- Education
- Computer descision programs
- IV -> PO switch
- Dosing programs
- Antibiogram
What is an antibiogram?
Periodic summary of antimicrobial susceptibilities of local bacterial isolates from the lab
Who qualifies for IV->PO conversion?
Clinically stable, normal diet, taking other PO meds
Benefits from IV-> PO?
- Comfort and mobility
- Reduced exposure to nosocomi pathogens
- Decreased phlebitis risk
- Reduced prep and admin time
- Lower cst
- Decreased length of stay
What is the significance of renal dosing?
Many antimicrobials need renal adj (vanc, AG)
What is MDRO?
Microorganisms (mainly bacteria) that are resistant to one or more clasees of ABX
How does resistance develop?
- Overuse of ABX can lead to the development of resistant strains of bacteria
* ABX use increases risk of developing ABX resistance - ABX resistance is a serious patient safety and public health threat
What are the common mechanisms of resistance?
- Decreased cellular permeaility
- Efflux pumps
- Altered drug targets
- Inactivating enzymes (b-lactams)
- Genetic mutations, new genes, transfer of genes
What are the risk factors of ABX resistance?
- Higher mortality
- Worse outcomes
- Higher healthcare costs
Identify the risk facotrs for MRSA?
- Antibiotic use
- HIV infection
- Injection drug use
- Presence of an indwelling HD catheter
- Residence in a LTC facility
MSSA tx?
- Nafcillin
- Oxacillin
- Dicloxacillin
- Cefazolin
- Cephalexin
MRSA Tx?
- Vanc
- Linezolid
- Daptomycin
RF of VRE
- Past antimicrobial therapy
- Patient characteristics:
* Hospitalization >72H
* Significant underlying med conditions
* PPI
* ICU care
* Invasive devices
Tx for enterococcus?
- Penicillin G
- Ampicillin
- Amoxicillin PO
- Ampicillin sulbactam (if beta-lactamase is present)
- Vanc (pen resistant)
Tx for VRE?
Daptomycin
Linezolid
RF of ESBL?
- Colonization of GIT
- CA infection (abx use, use of CS, percutaneous feeding tube)
- Traveling abroad
Enterobacteriaceae tx?
Kleb.
1. Ceftriazone
2. Zosyn
3. Ciprofloxacin
4. Levofloxacin
Tx for ESBL producing Kleb or E coli?
- Meropenem
- Ertapenem
- Imipenem
