Paul Wade AMS 20 Marks Flashcards
Give an outline antimicrobial stewardship. What is it?
Antimicrobial stewardship is a package of measures designed to:
- Provide effective, safe and economic use of antibiotics while also preventing resistance development.
- Consists of Core and Supplemental Strategies
- Consists of a AMS Stewarship committe
- Consists of an Antimicrobial Stewarship team
Collaboration between the antimicrobial stewardship team and the pharmacy therapeutics committes are essential
what eight elements may be considered and prioritized as supplements to the core active antimicrobial stewardship strategies?
gas comes out really paced. e.g a fart. PACED GAS
- Parenteral to oral conversion
- Antimicrobial cycling.
- Combination therapy
- Education
- Dose optimization
- Guidelines and clinical pathways
- Antimicrobial order forms
- Streamlining or de-escalation of therapy
What are the core strategies and what do they provide?
There are 2 core strategies, both proactive, that provide the foundation for an antimicrobial stewardship program.
- Prospective audit with intervention and feedback_._
Prospective audit and feedback is a method that allows the antimicrobial stewardship program to interact directly with prescribers in order to tailor specific antibiotic therapy for each patient. These strategies are employed after the initial prescribing and dispensing of the antibiotic.
- Formulary restriction and preauthorization
This is the most effective method of achieving the process goal of controlling antimicrobial use. Most hospitals have a pharmacy and therapeutics committee or a group that evaluates drugs for inclusion on the hospital formulary on the basis of considerations of therapeutic efficacy, toxicity, and cost while limiting redundant new agents with no significant additional benefit.
Describe ‘education’ as a supplemental stategy for AMS
Education is considered to be an essential element of any program designed to influence prescribing behavior and can provide a foundation of knowledge that will enhance and increase the acceptance of stewardship strategies.
However, education alone, without incorporation of active intervention, is only marginally effective in changing antimicrobial prescribing practices.
describe the role guidelines and clinical pathways plays in AMS
Multidisciplinary development of evidence-based practice guidelines incorporating local microbiology and resistance patterns can improve antimicrobial utilization. Guideline implementation can be facilitated through:
- Providing education
- Feedback on antimicrobial use
- Checking Patient outcomes
describe the role Antimicrobial cycling plays in AMS
Substituting one antimicrobial for another may transiently decrease selection pressure and reduce resistance to the restricted agent.
describe the role Antimicrobial order forms play in AMS
It can facilitate implementation of practice guidelines
describe the role combination therapy plays in AMS
critically ill patients at risk of infection with multidrug-resistant pathogens can be given combination therapy to increase the breadth of coverage and the likelihood of adequate initial therapy.
Inadequate initial antimicrobial therapy was found to be an independent risk factor for mortality in nonurinary infections due to extended-spectrum b-lactamase–producing Escherichia coli and Klebsiella species
describe the role streamlining or de-escalation of therapy plays in AMS
de-escalation on the basis of culture results and elimination of redundant combination therapy can more effectively target the causative pathogen, resulting in decreased antimicrobial exposure and substantial cost savings
describe the role dose optimisation plays in AMS
Optimization of antimicrobial dosing based
- Individual patient characteristics
- Causative organism
- Site of infection
- Pharmacokinetic and pharmacodynamic characteristics of the drug
Is an important part of antimicrobial stewardship
describe the role Parenteral to oral conversion (aka IV-Oral) plays in AMS
A systematic plan for iv-oral switch of antimicrobials with good bioavailability, when the patient’s condition allows, can decrease the length of hospital stay and health care costs
What role does IT support play in AMS?
Health care IT in the form of:
- Electronic medical records
- Computer physician order entry
- Clinical decision support
Can Improve antimicrobial decisions through the incorporation of data on patient-specific microbiology cultures and susceptibilities, hepatic and renal function, drug-drug interactions, allergies, and cost.
What role does the clinical microbiology laboratory play in AMS?
It provides patient-specific culture and susceptibility data to optimize individual antimicrobial management and by assisting infection control efforts in the surveillance of resistant organisms and in the molecular epidemiologic investigation of outbreak.
what is a key point to remember if core active strategies can’t be fully achieved?
On the basis of an understanding of local antimicrobial use and resistance problems and of available resources that may differ depending on the size of the institution, the core active strategies may be supplemented by education, guidelines and clinical pathways, antimicrobial order forms, adequate empirical therapy followed by de-escalation based on culture results, dose optimization, and a systematic plan for conversion from parenteral to oral therapy
where did this AMS detail come from
IDSA/SHEA position paper for antimicrobial stewardship 2007
