Lecture 9- Antimicrobial Stewardship Flashcards
How does resistance develop?
Less so about strains developing resistance but rather strains with natural resistance being selected for
What is the problem with antimicrobial resistance and antiobiotic treatment?
Antibiotics that can be used are often very expensive or very toxic.
Antimicrobial resistance and pharmaceutical companies?
Pharmaceutical companies are reluctant to develop new antibiotics as resistance may develop quickly and the antibiotic would become useless
How do you deal with resistant bacteria?
Resistance cannot be reversed. Can only allow bacteria to die out or eliminate it
Consequences of antibacterial resistance?
Treatment failure
Prophylaxis failure
Economic costs
Definitions of antimicrobial resistance?
Multi drug resistant
Extensively drug resistant
Pan drug resistant
Not multi drug resistant
What is a multi drug resistant bacteria?
One that is resistant to at least one agent in three or more categories
What is an extensively drug resistant bacteria? (XDR)
Resistant to at least one agent in all but two or fewer categories
What is a pan resistant bacteria?
Resistant to all agents in all categories
What is a not MDR bacteria?
Resistant to one or more agents in two or fewer categories
Evidence that antibacterials cause resistance?
Ecological studies- levels of antibiotic use in population and levels of resistance
Laboratory evidence
Individual level data- antibiotic use and subsequent resistant bacteria in the individual
Individual level data outcome resistance?
Longer durations and multiple courses lead to higher resistance rates
What is antimicrobial stewardship?
Appropriate use of antimicrobials
Optimal clinical outcomes
Minimised toxicity
Reduced infections costs
Limit selection of antimicrobial resistant strains
What’s involved in antimicrobial stewardship programme?
Surveillance including outcome and process measures
Interventions including those that are persuasive, restrictive and structural
Persuasive intervention?
Reminders eg patient been on antibiotic 5 days can we stop
Audits
Education
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