Drug Resistance and Antimicrobial stewardship Flashcards
Todays Lecture:
outline
Case 1:
When is antibiotics important - future infections? (decreased efficacy from prophylaxis antibiotics) Look at graph
What are the impact of drug resistance on patients?
- Appropriate initial therapy improves overall survival.
- Resistance BSIs prolong length of stay.
- Significant extra cost to system
Australia has highest usage in hospital antibiotic prescribing in western world. Community usage: 6th ranked in the world in community prescribing
Remember-
Global resistance and development: Look at how decreased funding- leads to increased resistance
What can we better do to prevent resistance?
- Very few novel antibiotics have come onto the market in past 20 years
- Need to keep new antimicrobials in reserve
How do we prevent infection (prevention and control in hospital)
- Vaccination
- Hand hygiene
- removal of devices that can cause increased infection (e.g Urianry catheter)
What can better diagnostics do to help antimicrobial resistance?
- there is greater prevalence of rapid testing- but does it change your management? (need to consider this)
What is Antimicrobial stewardship (AMS)? How is it implemented?
What does stewardship lead to in patients?
- Improve individual patient outcomes
- Reduce complications of antimicrobial use- Adverse drugs effects, infusion complications (e.g IV line infections), Drug resistant infections
- Saving money by preventing complications
What does the impact of AMS programs make on patients and healthcare system?
What are factors associated with resistance?
OVERALL FOLLOW guidelines!!!
What is an AMS program?
- Education
- Decision support - Guidelines, procedure, protocols
- Post -prescription review: - The antibiotic round
- Formulary management
Education on Stewardships:
only 1/3 of med students self-rate antibiotic knowledge to be adequate
About half of patinet presenting to GP with URTIS expect Antibiotics:
NICHE Find your antibiotic: CHOOSING antibiotics
Need?
Investigation?
Choice?
How long?
Evaluate?
How do should you think about infection: e.g what is the diagnosis? Which bugs most likely? Which cause this syndrome? What samples can i take of this bug? Which antibiotics should i use? ETG!! Does the patients have any allergies or contraindications
Antibiotic Prescribing in Primary care Guidelines:
Antibiotic Prescribing in Primary care Guidelines: continued
How can better diagnostic test help with infection?
What tests are most important?
Biomarkers infection:
CRP - Pros and cons
Treat the patient not the numbers!
Clinical example: Case 1:
How would you empirical treat this patient? Complex UTI?
- UTI, Cystitis,
- Tests: urine MCS, Blood cultures and routine bloods,
- Empiric ampicillin and Gentamicin (depend on renal fn)
- Check results: Urine, Blood cultures
- Narrow antibiotics: Cease Gent on day 3
- Change to orals: Amoxicillin 500mg TDS
- Cease after 10 days as infection complicated by BSI
Rules of thumb:
What is pathogenesis of UTI (e.g top 4 bugs)?
UTI management:
Signs and symptoms?
Investigations?
Recommendation for management of UTI:
Post prescription Review:
STOP: What does this stand for? (stopping antibiotics)
Acute respiratory illness:
Asthma- Most exacerbations are non infectious, Most infectious exacernbations are viral, mainstay
What About COPD exacerbations? What do you need to ask? (systemic illness, fever, sputum production, change in colour in sputum) - 3 signs of infective exacerbations!
Patient focused COPD data:
How do we best treat IE of COPD? (what important things to note)
Pneumonia
Ask?
Prescribe what? What not to?
Skin, Soft tissue, Bone and Joint infections:
What is Simple cellulitis? What is your DDx?
Remember to check for tinea pedis- entry of infection- Common
Frequently gets worse before it gets better:
Surgical prophylaxis: Antibiotics
- When is it best given?
- Remember to differentiate treatment from prophylaxis!!!
When should we get ID involved in patient treatment?
Conclusions:
Key points!
