Infection 5 Antimicrobial Resistance + Stewardship Flashcards
What drives resistance?
ALL antibiotic usage
Consequences of antibacterial resistance
Treatment failure
Prophylaxis failure
Economic costs - longer hospital stay
What evidence is there that antibacterial cause resistance?
Laboratory evidence
Ecological studies
Individual level data
How does laboratory evidence provide evidence that antibacterials cause resistance?
Provides biological plausibility
How does ecological studies provide evidence that antibacterials cause resistance?
Relates levels of antibacterial use with levels of resistance
How does individual level data provide evidence that antibacterials cause resistance?
Relates prior antibacterial use with subsequent resend of bacterial resistance
What is antimicrobial stewardship?
Coordinated program that promotes appropriate use of antibiotic
What does antimicrobial stewardship aim to do?
- Increase clinical outcomes
- Minimise toxicity
- Decrease costs
- Limit selection for antimicrobial resistance strain
Multi drug resistant definition
Non-susceptibility to at least 1 agent in 3 or more antimicrobial categories
Extensively drug resistant definiton
Non-susceptibility to at least 1 agent in all but 2 or less antimicrobial categories
Pan-drug resistant definition
Non-susceptibility to all agents in all antimicrobial categories
What are the elements of an AMS programme?
- MDT
-
Surveillance- outcome measures
- process measures -
Intervention- persuasive
- restricted
- structural
What do process measures take into account?
Dose
Class
Appropriateness
Institution comparison
What do outcome measures take into account?
Patient outcomes
Emergence of resistance
Clostridium difficult infection rate
What does persuasive intervention encompass?
Education
Reminders
Feedback
Audits
Consesus
