CD - AMR, IPAC, precautions

Question 1

what is antimicrobial resistance (AMR) (1)

Answer 1

1- ability of a microbe to resist the effects of an antimicrobial medication

Question 2

what is intrinsic resistance (1)

Answer 2

1- naturally coded and expressed by most members of a species (e.g. resistance of gram-negative bacteria to vancomycin)

Question 3

what is acquired resistance (2)

Answer 3

1- changes due to mutation and selective pressure or horizontal gene transfer that leads to resistance against a particular antibiotic
2- limited to selected isolates of a species (e.g. MRSA, VRE)

Question 4

what is biological resistance (1)

Answer 4

1- microorganism less susceptible to an antimicrobial than previously observed; ongoing process

Question 5

what is clinical resistance (1)

Answer 5

1- biological resistance that is
sufficient to make drug no longer effective for use

Question 6

what is cross-resistance (1)

Answer 6

1- variety of genetic determinants encode resistance to several antimicrobial agents at the same time, usually in the same class

Question 7

what is multidrug resistance (1)

Answer 7

1- multiple unrelated resistance genes in the same organism

Question 8

what is an antibiogram (1)

Answer 8

1- susceptibility report for a particular hospital or geographic area that can guide empiric therapy before susceptibility data are available

Question 9

what are factors that contribute to AMR - OMBSMN (6)

Answer 9

1- overuse of antibiotics, particularly broad-spectrum
2- misuse of antibiotics (e.g. for viral infections)
3- prescribing before testing sensitivity
4- stopping before treatment is completed (e.g. stopping TB meds leading to MDR TB)
5- medical conditions requiring recurrent antibiotic use (e.g. indwelling catheter, decubitus ulcers)
6- prolonged hospitalization/nosocomial infection (e.g. ventilator-associated infections)

Question 10

what are factors that can contribute to the transmission of drug-resistant strains, especially in healthcare settings -H-PIFI (5)

Answer 10

1- lapses in IPAC, related to limited resources or increased workload
2- spread in fertile environments (e.g. hospitals)
3- lack of compliance of HCWs with hand hygiene
4- increased use of invasive devices/procedures
5- growing population of higher risk patients

Question 11

what are reasons for drug-resistance strain emergence - IAD like Dulles airport (3)

Answer 11

1- increased global trade and travel
2- antibiotic use in animal husbandry as prophylaxis against infectious diseases or for growth promotion
3- direct transmission from animals to farm works

Question 12

what is a general framework for addressing AMR - SIRS (4)

Answer 12

1- surveillance
2- IPAC
3- research
4- stewardship

Question 13

re: framework for addressing AMR, what does surveillance mean (1)

Answer 13

1- detect, track and monitor emerging and re-emerging resistant organisms, and drug-resistant infections

Question 14

re: framework for addressing AMR, what does IPAC mean (1)

Answer 14

1- non-antimicrobial strategies that prevent infections

Question 15

what are some examples of non-antimicrobial strategies that can prevent infections (re: framework for addressing AMR) - HEFS (4)

Answer 15

1- hand and respiratory hygiene
2- equipment (sterilization and disinfection)
3- food handling and processing that is proper
4- sanitation (environmental hygiene)

Question 16

re: framework for addressing AMR, what does research mean (1)

Answer 16

1- develop new antimicrobials and diagnostic tools

Question 17

re: framework for addressing AMR, what does stewardship mean (1)

Answer 17

1- reduce inappropriate prescribing, dispensing and use of antimicrobials in humans/animals to conserve effectiveness of new and existing drugs

Question 18

what are some AMR-related pan-Canadian surveillance systems - CARSS, CIPARS, CNISP (3)

Answer 18

1- Canadian antimicrobial resistance surveillance system (CARSS)
2- canadian integrated program for antimicrobial resistance surveillance (CIPARS)
3- canadian nosocomial infection surveillance program (CNISP)

Question 19

what are priority organisms for surveillance re: AMR in Canada - CC-MV-SS-NM-TN (10)

Answer 19

1- Carbapenemase-producing Enterobacteriaceae
2- Clostridioides difficile
3- Methicillin-resistant Staphylococcus aureus
(MRSA)
4- Vancomycin resistant Enterococcus (VRE)
5- Streptococcus pyogenes
6- Streptococcus pneumoniae
7- Neisseria gonorrhoeae
8- Mycobacterium tuberculosis
9- Typhoidal Salmonella enterica
10- Non-typhoidal Salmonella enterica

Question 20

what are the features of hospital antibiotic stewardship programs - TRAMPLE (7)

Answer 20

1- tracking
2- reporting
3- accountability
4- measures
5- pharmacy expertise
6- leadership commitment
7- education

Question 21

re: features of hospital abx stewardship programs, what is ‘tracking’ (1)

Answer 21

1- tracking antibiotic prescribing and resistance

Question 22

re: features of hospital abx stewardship programs, what is ‘reporting’ (1)

Answer 22

1- report tracking results to staff

Question 23

re: features of hospital abx stewardship programs, what is ‘accountability’ (1)

Answer 23

1- appoint a single leader as responsible for program outcomes

Question 24

re: features of hospital abx stewardship programs, what is ‘measures’ (3)

Answer 24

measures include:
1- prior authorization
2- audit and feedback
3- automatic changes from IV to PO

Question 25

re: features of hospital abx stewardship programs, what is ‘pharmacy expertise’ (1)

Answer 25

1- appoint a single pharmacist as responsible for improving antibiotic use

Question 26

re: features of hospital abx stewardship programs, what is ‘leadership commitment’ (1)

Answer 26

1- dedicate the necessary human, financial and IT resources to AMR stewardship

Question 27

re: features of hospital abx stewardship programs, what is ‘education’ (1)

Answer 27

1- provide education to HCWs on optimal prescribing of antimicrobials