Lecture 2.0 - Antimicrobial Stewardship Notes

Question 1

Why is AMR a problem?

Answer 1

• It reduces effectiveness of existing agents
• Prolonged hospitalisation, increased complications
• Increased morbidity and mortality
• Shedding of AMR genes into environment
• AM needed to treat resistant infections more expensive
• AM needs to be given IV
• Toxicity of agents used

Question 2

The WHO developed a priority pathogen list for research and development (R&D) of new antibiotics. There are 3 priorities. Which pathogens constitute priority 1 (the CRITICAL paths) ?

Answer 2

• Carbapenem-resistant Acinetobacter baumannii
• Carbapenem-resistant Pseudomonas aeruginosa
• Carbapenem-resistant;- 3rd generation cephalosporin resistant- Enterobacteriaceae (CRE)

Question 3

Which pathogens constitute priority 2 (the HIGH priority)?

Answer 3

• Vancomycin-resistant Enterococcus faecium (VRE)
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Clarithromycin-resistant Helicobacter pylori
• Fluoroquinolone-resistant Campylobacter species
• Fluoroquinolone-resistant - Salmonella
• 3rd generation cephalosporin resistant; Fluoroquinolone-resistant- Neisseria gonorrhea

Question 4

Which pathogens constitute priority 3 (the MEDIUM priority)?

Answer 4

• Streptococcus pneumoniae; -Penicillin-non-susceptible
• Haemophilus influenza: ampicillin resistant
• Shigella spc: fluroquinolone resistant

Question 5

What is antimicrobial stewardship?

Answer 5

Coherent set of actions that promotes the judicious/appropriate use of
antimicrobials

Question 6

AMS operates at multiple levels. Which are those?

Answer 6

• individual,
• national,
• and global levels

Question 7

What are the 3 pillars of an integrated approach to healthcare?

Answer 7

AMS, IPC, patient safety

Question 8

What are the AMS interventions to consider?

Answer 8

• R – Restriction (restricting the use of certain antimicrobial agents, particularly those deemed high-risk or reserved for specific indications)
• E – Education
• W – Ward rounds
• A – Audits/Antibiograms
• R – Review
• D – Direction (Guidelines, Feedback)

Question 9

What is intrinsic resistance?

Answer 9

Intrinsic resistance refers to the natural ability of certain microorganisms to resist the effects of antibiotics or other antimicrobial drugs.

*This resistance is not acquired over time but is instead built into the genetic makeup of the microorganism.