Final: Antibiotic Stewardship

Question 1

What microorganisms are antimicrobial threats?

Answer 1

Carbapenem-resistant Acinetobacter
Carbapenem-resistant Enterobacterales
ESBL-producing Enterobacterales
Vancomycin-resistant Enterococcus (VRE)
MDR P. aeruginosa
MRSA

Question 2

What are 3 problems with prescribing antibiotics?

Answer 2

Low threshold for prescribing
Broad-spectrum empiric initiated but never deescalated
Use of suboptimal regimens

Question 3

Repercussions of inappropriate therapy on the PATIENT: (6)

Answer 3

Inadequate treatment
Adverse Effects
Allergic reaction
Superinfection
Resistance
Selection of problematic pathogens (C. Diff)

Question 4

Repercussions of inappropriate therapy on SOCIETY: (2)

Answer 4

Antimicrobial resistance (collateral damage)
Increased healthcare costs

Question 5

What are some benefits of antimicrobial stewardship? (5)

Answer 5

Improved patient outcomes
Decreased AEs
Increased antibiotic susceptibility
Resource optimization
Reduced healthcare costs

Question 6

What are the 7 CORE ELEMENTS of Hospital Antimicrobial Stewardship programs (ASPs)?

Answer 6

Hospital Leadership Commitment
Accountability
Pharmacy Expertise
Action (implementation)
Tracking
Reporting
Education

Question 7

What 2 government groups support stewardship?

Answer 7

Joint Commission
Centers for Medicare and Medicaid Services

Question 8

Pharmacy Based Interventions (7)

Answer 8

Documentation of indications
IV to PO
Dose adjustment
Time-sensitive automatic stops
Penicillin allergy assessment
Detection of Abx-related DDIs
Formulary restriction

Question 9

What is the key phrase of antimicrobial stewardship?

Answer 9

Shorter is Better!!

Question 10

What is the STOP-IT trial?

Answer 10

Showed no significant difference between 4 and 8 days of therapy (so use 4 days!)

Question 11

Only __% of penicillin allergies are true IgE Type 1 allergies.

Answer 11

10%

Question 12

What are some alternatives for people with penicillin allergies?

Answer 12

Vancomycin
Fluoroquinolones
Clindamycin
Aztreonam

Question 13

Use empiric treatment when:

Answer 13

We are unsure what bug is afflicting the patient (but we have a general idea)

Question 14

Best Abx for MSSA

Answer 14

Nafcillin (oxacillin, dicloxacillin)
Cefazolin, Cephalexin

Question 15

Best Abx for MRSA (hospital and community Acq)

Answer 15

Hospital Acq: Vancomycin, Linezolid, Daptomycin, Ceftaroline
Community Acq: Clindamycin, Bactrim, Doxycycline

Question 16

Best Abx for Streptococci (Gram +)

Answer 16

Penicillins
Cephalosporins
Vancomycin
Respiratory quinolones

Question 17

Best Abx for Enterococci

Answer 17

Ampicillin
Vancomycin/Linezolid/Daptomycin

NO Cephalosporins!

Question 18

Best Abx for Pseudomonas

Answer 18

Pip/Tazo
Cefepime
Ceftazidime, Ceftazidime/avibactam
Carbapenems (not ertapenem)

Fluoroquinolones (no moxi)
Aminoglycosides

Question 19

Best Abx for Acinetobacter

Answer 19

High resistance!

Meropenem
Unasyn
Cefiderocol

Question 20

What can we use to treat Beta-lactamase producers?

Answer 20

Penicillinases (Unasyn, Augmentin, Zosyn)
Extended Spectrum Beta-lactam (ESBL) (carbapenems, Zosyn)
Carbapenem Resistant Enterobacteriacae (CRE)
- Ceftazidime/avibactam, cefiderocol

Question 21

Best Abx for anaerobes

Answer 21

Oral: Clindamycin, Unasyn, Zosyn, augmentin
Intestinal: Metronidazole, Unasyn, augmentin, Zosyn, carbapenems

Question 22

Best Abx for C. Diff

Answer 22

Fidoxomicin
Vancomycin
Metronidazole (fulminant only)

Question 23

What are the HECK Yes organisms?

Answer 23

Hafnium alvei
Enterobacter cloacae
Citrobacter freundii
Klebsiella aerogenes
Yersinia enterocolitica

Question 24

What abx should we use for HECK Yes organisms?

Answer 24

Cefepime
Zosyn
Carbapenem