infection - antibiotic stewardship

Question 1

consequences of antibacterial resistance?

Answer 1

treatment failure
prophylaxis failure
economic costs

Question 2

what is multi-drug resistance (MDR)?

Answer 2

non-susceptibility to at least 1 agent in 3(+) antimicrobial categories
(at least 3 groups)

Question 3

what is extensive drug resistance (XDR)?

Answer 3

non-susceptibility to at least 1 agent in all but 2 or fewer antimicrobial categories
(all categories except 1 or 2)

Question 4

what is pan-drug resistance (PDR)?

Answer 4

non-susceptibility to all agents in all antimicrobial categories
(everything)

Question 5

what is the definition of antimicrobial stewardship?

Answer 5

appropriate use of antimicrobials
optimal clinical outcomes
minimise toxicity & other adverse events
reduce cost of healthcare for infections
limit the selection for antimicrobial resistant strains (blood culture)

Question 6

what are the antimicrobial stewardship relationships?

Answer 6

antimicrobial stewardship
infection prevention
environmental decontamination

Question 7

what are the types of stewardship interventions?

Answer 7

1. persuasive: education, consensus, feedback
2. restrictive: formulary restriction, restricted susceptibility reporting
3. structural: computerised records, rapid lab tests, quality monitoring

Question 8

what are the outcome measures?

Answer 8

patient outcomes
emergence of resistance
C. diff infection rate

Question 9

what are the requirements for successful stewardship?

Answer 9

long term confirmed & appropriate resources
hospital leadership support and delegated authority to challenge / change inappropriate antimicrobial therapy
integration into organisation patient safety & quality of care structure & process