MRSA + VRE AMR

Question 1

List the key organisms that cause infections which can lead to morbidity and mortality?

Answer 1

• Escherichia coli
• Klebsiella pneumoniae
• Enterococcus faecium
• Pseudomonas aeruginosa
• MRSA

Question 2

What are the consequences of inappropriate and overuse of antibiotics?

Answer 2

Antibiotic resistance and select for resistant mutants

Question 3

What is the defined daily dose?

Answer 3

statistical measure of drug consumption

Question 4

How is antibiotic use measured in primary care?

Answer 4

Antibiotic use measured in primary care= increased when measured by DDD and decreased when measured by prescription which means longer courses and higher doses are being used

Question 5

What is the order from most to least prescribed antibiotics?

Answer 5

Penicillin
tetracyclines
macrolides

Question 6

What antibiotics are used in secondary care?

Answer 6

Carbapenems

piperacillin-tazobactam

Question 7

When should secondary care antibiotics be used?

Answer 7

for resistant infections and used only when standard antibiotics are ineffective

Question 8

What is the role of the • English surveillance programme for antimicrobial utilisation and resistance programme?

Answer 8

monitors the prescribing of antibiotics and the way they are obtained from pharmacies

Question 9

What bacteria does antibiotics resistant give rise to?

Answer 9

MRSA
Multi resistant coliforms
GRE/VRE
C.difficile

Question 10

What is MRSA?

Answer 10

Methicillin resistant staphylococcus aureus bacteria

Question 11

What antibiotics is MRSA resistant to?

Answer 11

	B lactams
	Methicillin
	Penicillin’s (including flucloxacillin)
	Cephalosporins 
	Carbapenems
	Macrolides (e.g. erythromycin) 
	Quinolones (e.g. ciprofloxacin)
	Clindamycin

Question 12

What is the MOA of MRSA?

Answer 12

 Horizontal transfer of SCCmec
 This contains mecA gene
 This encodes for PBP2- penicillin binding protein 2
 This has reduced affinity for the antibiotic class beta lactams
 Beta lactamase enzymes cleave and inactivate antibiotic

Question 13

What groups of people are at highest risk of MRSA?

Answer 13

Nursing home resident

hospital attendees

Question 14

What body sites does MRSA colonise?

Answer 14

 Nose
 Armpit
 Groin
 Skin

Question 15

In what ways can MRSA hospital infection be reduced?

Answer 15

 Screen at risk patients
 Isolate patient
 Decontamination therapy= skin wash, nasal ointment and mouthwash should be prescribed for 5 days
 All staff and patients wash hands
 Aseptic techniques of care= IV drug administration/catheter insertion
 Antibiotic prophylaxis against MRSA for surgery in colonised patients
 Antibiotic stewardship

Question 16

How are MRSA colonised patients treated?

Answer 16

Decontamination

Question 17

How are infected MRSA patients treated?

Answer 17

1. IV vancomycin or teicoplanin are 1st line

2. Linezolid, daptomycin, tigecycline are 2nd line

Question 18

What are the symptoms of MRSA infection?

Answer 18

1. Fever
2. High WBCC
3. Inflammation at site of infection

Question 19

What are the disadvantages of using 2nd line MRSA infection antimicrobials?

Answer 19

 Expensive
 Toxic
 Intensive monitoring

Question 20

What are GRE and VRE?

Answer 20

GRE- GLYCOPEPTIDE RESISTANT ENTEROCOCCI

VRE- VANCOMYCIN RESISTANT ENTEROCOCCI

Question 21

What is enterococci?

Answer 21

gram positive organism in gut

Question 22

What does GRE colonise?

Answer 22

bowel

Question 23

What is the MOA of GRE/VRE?

Answer 23

Vancomycin resistant enterococci make cell wall precursors that have low affinity for vancomycin
Cell-wall precursors ending in d-alanyl-d-lactate (d-Ala-d-Lac), to which vancomycin binds with very low affinity
Vancomycin susceptible enterococci prevent synthesis of or modify endogenous cell-wall precursors ending in d-alanyl-d-alanine (d-Ala-d-Ala), to which vancomycin binds with high affinity

Question 24

What are the consequences of the spread and emergence of antibiotic resistance in hospitals?

Answer 24

• Causes increase in morbidity and mortality
• Increases hospital length stay
• Delays appropriate antibiotic therapy= worse patient outcomes/death

Question 25

Define antibiotic misuse?

Answer 25

- Antibiotics prescribed unnecessarily - Delay of administration in critical illnesses - Broad spec antibiotics used to generously - Narrow spec used incorrectly - Lower or higher dose than needed - Duration of treatment too long or too short - Treatment is not streamlined according to microbiological culture data results

Question 26

How is VRE transmitrted?

Answer 26

person to person touching | medical devices/infected surface contact

Question 27

What is used to treat VRE colonisation?

Answer 27

no treatment needed

Question 28

What is used to treat VRE infections?

Answer 28

linezolid tigecycline teicoplanin daptomycin

Question 29

How is VRE spread managed and prevented?

Answer 29

aprons and gloves for HCP handwashing avoid touching medical devices

Question 30

Describe the antibiotic stewardship role of a pharmacist?

Answer 30

Ensure rational use Health promotion to reduce use of antibiotics when it’s not needed- cough or cold Prescriber education Development/promotion of empiric guideline choice Restriction of reserve antibiotics Selective reporting of sensitivities to guide prescribing to 1st line or narrow spec antibiotics Ensure justified indication Ensure Choice Dose optimisation Ensuring correct duration

Question 31

Describe the pharmacist checklist for antibiotic therapy monitoring?

Answer 31

- Does the patient have an infection? - What is the diagnosis? - Is the choice of antibiotic according to guidelines / C&S? - Has the allergy status been checked? - Is the dose correct – consider renal / hepatic function, age - Check contraindications / interactions - Have appropriate samples been sent? - Is the course length stated? What course length is recommended for this condition? - Is monitoring required e.g. TDM? - Is the patient responding? - Can treatment be tailored according to C&S to narrow spectrum? - Is the patient experiencing side effects? - Can IV be changed to oral? - Can the antibiotics be stopped?