S8 Antimicrobial Resistance and Stewardship

Question 1

What is horizontal gene transfer?

Answer 1

Transfer of already present genes between bacteria

Question 2

Does all exposure of bacteria to antimicrobials lead to resistance?

Is resistance reversible?

Answer 2

Yes

No

Question 3

What are 3 general consequences of antibacterial resistance?

Answer 3

• treatment failure
• prophylaxis failure
• economic cost - increase

Question 4

What does multi-drug resistance (MDR) mean?

Answer 4

Microbe has non-susceptibility to at least one agent in three or more antimicrobial categories

Question 5

What does extensively drug resistant (XDR) mean?

Answer 5

Microbe has non-susceptibility to at least one agent in all but two or fewer antimicrobial categories

Question 6

What does pan-drug resistant (PDR) mean?

Answer 6

Microbe has non-susceptibility to all agents in all antimicrobial categories

Question 7

What is the discovery void?

Answer 7

No new antimicrobials have been discovered since 1987

Question 8

What causal relationship does antimicrobial stewardship depend on?

Answer 8

Causal relationship that antibacterial use causes resistance

Question 9

What evidence is there that antibiotics cause resistance?

Answer 9

• LAB EVIDENCE - biological plausibility
• ECOLOGICAL STUDIES - relates levels of antibacterial use in population with levels of resistance
• INDIVIDUAL LEVEL DATA - related prior antibacterial use in an individual with subsequent presence of bacterial resistance - detected by e.g. culture

Question 10

What is antimicrobial stewardship?

Answer 10

Coordinated interventions to improve and measure and achieve:

• appropriate use of antimicrobials
• optimal clinical outcomes
• minimise toxicity and other adverse events
• reduce costs of healthcare for infections
• limit the selection for antimicrobial resistant strains

Question 11

What are the 3 intervention types?

Answer 11

• persuasive
• restrictive
• structural

Question 12

What are the 3 elements of an antimicrobial stewardship programme?

Answer 12

• multidisciplinary teams and relationships
• surveillance
• interventions

Question 13

What is the multidisciplinary team involved in antimicrobial stewardship?

Answer 13

• medical microbiologist/infectious diseases physician
• antimicrobial pharmacist
• infection control nurse
• hospital epidemiologist
• information system specialist

Question 14

What 2 things have a linking relationship with antimicrobial stewardship?

Answer 14

• infection prevention

* environmental decontamination

Question 15

What is involved in persuasive stewardship intervention?

Answer 15

• education
• consensus
• opinion leaders
• reminders
• audit
• feedback

Question 16

What is involved in restrictive stewardship intervention?

Answer 16

• restricted susceptibility reporting
• formulary restriction
• prior authorisation
• automatic stop orders (on prescriptions)

Question 17

What is involved in structural stewardship intervention?

Answer 17

• keep computerised records
• rapid lab tests
• expert systems
• quality monitoring

Question 18

What outcome measures need to be considered/monitored in antimicrobial stewardship?

Answer 18

• patient outcomes
• emergence of resistance
• Clostridium difficile infection rate

Question 19

Restrictive vs persuasive intervention outcomes, which is better?

Answer 19

Both work

* restrictive is just often faster