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PM3A: Autumn > Infections lecture 3: Antimicrobial Stewardship > Flashcards

Infections lecture 3: Antimicrobial Stewardship Flashcards

1
Q

What is the 5 year antimicrobial resistance strategy (7)

A
  1. Improving infection prevention and control practices
  2. Optimising Prescribing Practice (AMS)
  3. Improving professional education, training and public engagement
  4. Developing new drugs, treatments and diagnostics
  5. Better assess to and use of surveillance data
  6. Better identification and prioritisation of AMR research
  7. Strengthened international collaboration
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2
Q

What is the definition for antimicrobial stewardship

A

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)

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3
Q

What is the purpose of antimicrobial stewardship

A

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

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4
Q

What are the reasons for anti-microbial stewardship

A

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

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5
Q

What are the roles of individuals on the AMS team

A
  1. Clinical pharmacist with infectious disease expertise
  2. Clinical Microbiologist
  3. Infectious disease physician
  4. IT specialist
  5. Infection control professional nurse
  6. Hospital epidemiologist
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6
Q

What are some of the strategies that have been implemented by the antimicrobial stewardship into practice (9)

A
  1. Formulary/Restriction
  2. Review, audit and feedback
  3. Education and guidelines
  4. Prior approval programmes
  5. Streamlining or de-escalation
  6. Dose Optimisation
  7. IV to oral switch
  8. Antibiotic cycling
  9. Computer assisted prescribing
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7
Q

Explain what formulary restriction is

A

Restricting dispensing of certain antimicrobials to approved indication

Consultant microbiologist should recommend only

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8
Q

What are the advantages of formulary restriction

A

Direct control over antimicrobial use

Cost effective

Individual education opportunities

Individual intervention by pharmacist whenever possible

Automatic Awareness

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9
Q

What are the disadvantages of formulary restriction

A

Perceived loss of autonomy of prescribers

Always need a microbiologist

Time consuming

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10
Q

In the AMS scheme, what is reviewing and feedback

A

Daily review of targeted antimicrobials for appropriateness

Contact prescriber with recommendations of alternative therapy

Antimicrobial committee produces guidelines for 1st and 2nd line treatment

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11
Q

What are the advantanges of a reviewing and feedback scheme

A

Avoids autonomy loss

Individual education chances

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12
Q

what are the disadvantages of reviewing and feedback scheme

A

Compliance with voluntary recommendations

Work load of pharmacist

Reactive vs proactive

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13
Q

In the AMS scheme, describe education and guidelines

A

Creation of guidelines for antimicrobial use by NHS trust, government

Made by individual clinicians of educators to educate pharmacists, nurses, or physicians

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14
Q

what are the advantages of education and guideline schemes

A

Alters behaviour patterns: prescribers use guidelines when necessary

Voluntary

Avoids prescriber loss of autonomy (persons rights)

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15
Q

what are the disadvantages of education and guideline schemes

A

Passive education may or may not impact on behaviour

Ineffective by itself

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16
Q

In the AMS scheme, what are prior approval programmes

A

Prescriber contacts microbiologist for approval before they prescribe antibiotic

Used in combination with formulary restrictions and other measures

17
Q

What are the advantages and disadvantages of prior approval programmes

A

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

18
Q

in the AMS scheme, what is streamlining or de-escalation

A

Changing the initial empiric treatment to a results based therapy- based on microbiology lab report

Changing to a more tailored therapy

19
Q

What are the advantages of stream lining or de-escalation

A

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

20
Q

What are the disadvantages of stream lining or de-escalation

A

PHARMACIST overload

Sample processing time for microbiologist

21
Q

In the AMS scheme, what is IV to oral switch

A

Parenteral delivery started in hospital

Have to be able to switch to oral with no loss of efficacy

22
Q

What are antibacterial agents with good bioavailablity

A

Quinolones

Oxazolidinone’s

Metronidazole

Clindamycin

Linezolid

Rifampicin

Macrolide’s

23
Q

In the AMS scheme, what is antibiotic cycling

A

Scheduled rotation of antimicrobials used done by the antibiotic committee

Avoids resistance to single agent

Reduce or slow down resistance

24
Q

what are the advantages and disadvantages in antibiotic cycling

A

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

25
Q

What are the three supplementary strategies in the AMS scheme and describe them

A

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

PM3A: Autumn (20 decks)

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