Infection 8 - Antimicrobial Stewardship

Question 1

What are the consequences of antibacterial resistance?

Answer 1

1) Treatment failure
2) Prophylaxis failure
3) Economic burdens

Question 2

What is antimicrobial stewardship?

Answer 2

Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of
administration.

Question 3

Define:

1) Multi-drug resistance (MDR)
2) Extensively drug resistant (XDR)
3) Pan-drug resistant (PDR)

Answer 3

1) MDR = non-susceptability to at least one agent in three or more antimicrobial categories.
2) XDR = non-susceptability to at least one agent in all but two or fewer antimicrobial categories
3) PDR = non-susceptability to all agents in all antimicrobial categories

Question 4

What are the objectives of anti-microbial stewardship?

Answer 4

• Appropriate use of antimicrobials
• Optimise clinical outcomes
• Minimise toxicity and other adverse events
• Reduce costs of health care for infections
• Limit the selection for antimicrobial resistant strains

Question 5

What are the 3 elements of an anti-microbial stewardship programme?

Answer 5

1) Multi-disciplinary team - e.g.: microbiologist, pharmacist, infection control nurse, hospital epidemiologist.
2) Surveillance - of process measures and outcome measures
3) Interventions - persuasive (education, consensus etc), restrictive (stop orders, prior authentication) + structural (computerised records, rapid lab rests, monitoring)