Infections lecture 3: Antimicrobial Stewardship Flashcards
What is the 5 year antimicrobial resistance strategy (7)
- Improving infection prevention and control practices
- Optimising Prescribing Practice (AMS)
- Improving professional education, training and public engagement
- Developing new drugs, treatments and diagnostics
- Better assess to and use of surveillance data
- Better identification and prioritisation of AMR research
- Strengthened international collaboration
What is the definition for antimicrobial stewardship
An overarching program to change and direct antimicrobial use at a healthcare institution
The optimal selection, dosage and duration of Antimicrobial treatment that results in the best clinical outcome for the treatment or prevention of infection
(with minimal toxicity to patient and minimal impact on subsequent resistance)
What is the purpose of antimicrobial stewardship
Focusing on patient and public health
Reduction: total or targeted antimicrobial use
Decrease: inappropriate antimicrobial use
Improvement: susceptibility profile of hospital pathogens and clinical markers (length of stay, mortality)
Increase in appropriate use of selection, dosing, route, duration of therapy
What are the reasons for anti-microbial stewardship
Decreased survival in population with resistant pathogens
Increased morbidity
Resistance built up due to use of inappropriate agents
Cost
Increased antimicrobial use leads to increase of selection of resistant pathogens, costs, length of stay
Patient safety
What are the roles of individuals on the AMS team
- Clinical pharmacist with infectious disease expertise
- Clinical Microbiologist
- Infectious disease physician
- IT specialist
- Infection control professional nurse
- Hospital epidemiologist
What are some of the strategies that have been implemented by the antimicrobial stewardship into practice (9)
- Formulary/Restriction
- Review, audit and feedback
- Education and guidelines
- Prior approval programmes
- Streamlining or de-escalation
- Dose Optimisation
- IV to oral switch
- Antibiotic cycling
- Computer assisted prescribing
Explain what formulary restriction is
Restricting dispensing of certain antimicrobials to approved indication
Consultant microbiologist should recommend only
What are the advantages of formulary restriction
Direct control over antimicrobial use
Cost effective
Individual education opportunities
Individual intervention by pharmacist whenever possible
Automatic Awareness
What are the disadvantages of formulary restriction
Perceived loss of autonomy of prescribers
Always need a microbiologist
Time consuming
In the AMS scheme, what is reviewing and feedback
Daily review of targeted antimicrobials for appropriateness
Contact prescriber with recommendations of alternative therapy
Antimicrobial committee produces guidelines for 1st and 2nd line treatment
What are the advantanges of a reviewing and feedback scheme
Avoids autonomy loss
Individual education chances
what are the disadvantages of reviewing and feedback scheme
Compliance with voluntary recommendations
Work load of pharmacist
Reactive vs proactive
In the AMS scheme, describe education and guidelines
Creation of guidelines for antimicrobial use by NHS trust, government
Made by individual clinicians of educators to educate pharmacists, nurses, or physicians
what are the advantages of education and guideline schemes
Alters behaviour patterns: prescribers use guidelines when necessary
Voluntary
Avoids prescriber loss of autonomy (persons rights)
what are the disadvantages of education and guideline schemes
Passive education may or may not impact on behaviour
Ineffective by itself
In the AMS scheme, what are prior approval programmes
Prescriber contacts microbiologist for approval before they prescribe antibiotic
Used in combination with formulary restrictions and other measures
What are the advantages and disadvantages of prior approval programmes
Advantage: avoids loss of autonomy in prescribers
Disadvantage:
No limited approval opportunities with out of hours
Loss of education chance
Communication errors and inaccurate patient data
Antibiotics used despite no indication
Long term benefits not established
in the AMS scheme, what is streamlining or de-escalation
Changing the initial empiric treatment to a results based therapy- based on microbiology lab report
Changing to a more tailored therapy
What are the advantages of stream lining or de-escalation
Avoids lengthy use of broad spectrum antimicrobials
Patient tailored therapy
Targeting infected organism
Reduces risk of secondary infections
Inappropriate use of antimicrobials stopped
Cost saving
What are the disadvantages of stream lining or de-escalation
PHARMACIST overload
Sample processing time for microbiologist
In the AMS scheme, what is IV to oral switch
Parenteral delivery started in hospital
Have to be able to switch to oral with no loss of efficacy
What are antibacterial agents with good bioavailablity
Quinolones
Oxazolidinone’s
Metronidazole
Clindamycin
Linezolid
Rifampicin
Macrolide’s
In the AMS scheme, what is antibiotic cycling
Scheduled rotation of antimicrobials used done by the antibiotic committee
Avoids resistance to single agent
Reduce or slow down resistance
what are the advantages and disadvantages in antibiotic cycling
Advantages:
Reduce resistance by changing selective pressure
Disadvantages:
Difficult to ensure adherence with cycling protocol
theoretical concerns about effectiveness
Lack of well designed studies and evidence
Allergy or toxicity may stop use of non-cycling drug
What are the three supplementary strategies in the AMS scheme and describe them
Guidelines and clinical pathways- ensures high quality care if someone follows a guide
Antimicrobial order forms- decreases antimicrobial use in practice and useful for prophylaxis
Combination theory- prevents resistance and overgrowth of organisms
