MRSA + VRE AMR Flashcards
List the key organisms that cause infections which can lead to morbidity and mortality?
- Escherichia coli
- Klebsiella pneumoniae
- Enterococcus faecium
- Pseudomonas aeruginosa
- MRSA
What are the consequences of inappropriate and overuse of antibiotics?
Antibiotic resistance and select for resistant mutants
What is the defined daily dose?
statistical measure of drug consumption
How is antibiotic use measured in primary care?
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
What is the order from most to least prescribed antibiotics?
Penicillin
tetracyclines
macrolides
What antibiotics are used in secondary care?
Carbapenems
piperacillin-tazobactam
When should secondary care antibiotics be used?
for resistant infections and used only when standard antibiotics are ineffective
What is the role of the • English surveillance programme for antimicrobial utilisation and resistance programme?
monitors the prescribing of antibiotics and the way they are obtained from pharmacies
What bacteria does antibiotics resistant give rise to?
MRSA
Multi resistant coliforms
GRE/VRE
C.difficile
What is MRSA?
Methicillin resistant staphylococcus aureus bacteria
What antibiotics is MRSA resistant to?
B lactams Methicillin Penicillin’s (including flucloxacillin) Cephalosporins Carbapenems Macrolides (e.g. erythromycin) Quinolones (e.g. ciprofloxacin) Clindamycin
What is the MOA of MRSA?
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
What groups of people are at highest risk of MRSA?
Nursing home resident
hospital attendees
What body sites does MRSA colonise?
Nose
Armpit
Groin
Skin
In what ways can MRSA hospital infection be reduced?
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
How are MRSA colonised patients treated?
Decontamination
How are infected MRSA patients treated?
- IV vancomycin or teicoplanin are 1st line
2. Linezolid, daptomycin, tigecycline are 2nd line
What are the symptoms of MRSA infection?
- Fever
- High WBCC
- Inflammation at site of infection
What are the disadvantages of using 2nd line MRSA infection antimicrobials?
Expensive
Toxic
Intensive monitoring
What are GRE and VRE?
GRE- GLYCOPEPTIDE RESISTANT ENTEROCOCCI
VRE- VANCOMYCIN RESISTANT ENTEROCOCCI
What is enterococci?
gram positive organism in gut
What does GRE colonise?
bowel
What is the MOA of GRE/VRE?
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
What are the consequences of the spread and emergence of antibiotic resistance in hospitals?
- Causes increase in morbidity and mortality
- Increases hospital length stay
- Delays appropriate antibiotic therapy= worse patient outcomes/death
Define antibiotic misuse?
- 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
How is VRE transmitrted?
person to person touching
medical devices/infected surface contact
What is used to treat VRE colonisation?
no treatment needed
What is used to treat VRE infections?
linezolid
tigecycline
teicoplanin
daptomycin
How is VRE spread managed and prevented?
aprons and gloves for HCP
handwashing
avoid touching medical devices
Describe the antibiotic stewardship role of a pharmacist?
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
Describe the pharmacist checklist for antibiotic therapy monitoring?
- 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?
