Session 4-Antimicrobial Resistance And Stewardship

Question 1

What are the consequences of antibacterial resistance?

Answer 1

Treatment failure
Prophylaxis failure
Economic costs

Question 2

What is an MDR bacteria?

Answer 2

Multi-drug resistant

Question 3

What is an XDR bacteria?

Answer 3

Extensively drug resistant - non-susceptibility to at least one agent in all but two or fewer antimicrobial categories

Question 4

What is a PDR bacteria?

Answer 4

Pan-drug resistant - non-susceptibility to all agents in all antimicrobial categories

Question 5

What is the antibiotic discovery void?

Answer 5

Lack of new discoveries of antibiotics since 1980s

Question 6

Give evidence that antibacterial cause resistance (3)

Answer 6

1) laboratory evidence - provides biological plausibility
2) ecological studies - relates levels of antibacterial use in population with levels of resistance
3) individual level data - relates prior antibacterial use in individual with presence of bacterial resistance

Question 7

What are the objectives of the IDSA definition of antimicrobial stewardship? (5)

Answer 7

1) appropriate use of antimicrobials
2) optimal clinical outcomes
3) minimise toxicity and other adverse events
4) reduce costs of health care for infections
5) limit selection for antimicrobial resistant strains

Question 8

Which members of a multi-disciplinary team are involved in antimicrobial stewardship? (5)

Answer 8

1) medical microbiologist/infectious disease physician
2) antimicrobial pharmacist
3) infection control nurse
4) hospital epidemiologist
5) information system specialist

Question 9

What are the three types of stewardship interventions? (3)

Answer 9

1) persuasive
2) restrictive
3) structural

Question 10

What are the important factors of persuasive stewardship?

Answer 10

Education 
Consensus
Opinion leaders
Reminders
Audit
Feedback

Question 11

What are the important factors of restrictive stewardship?

Answer 11

Restricted susceptibility reporting
Formulary restriction
Prior authorisation
Automatic stop orders

Question 12

What are the important factors of structural stewardship?

Answer 12

Computerised records
Rapid lab tests
Expert systems
Quality monitoring

Question 13

What are the outcome measures of stewardship?

Answer 13

Patient outcomes
Emergence of resistance
C. Difficile infection rate