L8 - antimicrobial stewardship

Question 1

Give two consequences of antibacterial resistance

Answer 1

Treatment failure
Prophylaxis failure
Economic cost

Question 2

there are varying levels of antibiotic resistance, define the following:
a) MDR b) XDR c) PDR

Answer 2

a) Multi-drug resistant - non-susceptibility to at least one agent in three or more antimicroibal categories
b) Extensively drug resistant - Non-susceptibility to at least one agent in all but two or fewer antimicrobial categories
c) Pan-drug resistant - Non-susceptibility to all agents in all antimicrobial catgeories

Question 3

What evidence do we have that antibacterials cause resistance through use?

Answer 3

Labratory evidence/ Eocological studies that relate antibacterial use within a population to levels of resistnace/ Individual level data - relates prior antibacterial use in an indicidual with the subsequent presence of bacterial resistance

Question 4

what is antimicrobial stewardship?

Answer 4

Co-ordinated interventions designed to improve and measure the appropriate use of antimicrobials

Question 5

How can we measure the effects of antimicrobial stewardship?

Answer 5

Patient outcomes
Emergence of resistance
Clostridium difficile infection rate ( cos this is related to resistant antibiotic use)

Question 6

What are the objectives of anti-microbial stewardship?

Answer 6

• Appropriate use of antimicrobials
• optimise clinical outcomes
• Minimise toxicity and other side effects from them
• reduce cost
• reduce resistance

Question 7

What measures can we take to ensure the appropriate use of antimicrobials?

Answer 7

• Education
• Audits
• Automatic stop orders
• Computerised records
• Rapid lab tests

Question 8

Give two exotoxins released by staphylococcus aureus

Answer 8

haemolysins/catalase/superantigen/coagulase

Question 9

What are the two main organisms which cause cellulitis?
How do you differentiate between them under the microscope?
How would you treat?
What would you give if patient has a penicillin allergy?

Answer 9

Staphylococcus aureus and Streptococcus pyogenes

Catalase test
Aureus is clusters of cocci
pyogenes is chains of cocci

Flucoxicillin

doxycycline if resistant

(erythromycin in kids)

Question 10

give three infections caused by E. coli

What is the treatment for each?

Answer 10

traveller’s diarrhoea (fluids)/bloody diarrhoea (fluids)/UTI (trimethoprim)/perotinitis (trimethoprim)/septicaemia (trrimethoprim)/neonatal mengingitis (ceftriaxone)

Question 11

What are the three major organims causing community acquired pneumonia?

Treatment for each

Answer 11

Haemophilius influenzae (doxycyline)
Staph aureus (doxycycline)
Strep pneumonia (co-amoxiclav)