Session 5: Antimicrobial Stewardship

Question 1

Give three types of antimicrobial resistance.

Answer 1

MDR (multi-drug resistant)
XDR (extensively drug resistant)
PDR (pan-drug resistant)

Question 2

Define MDR.

Answer 2

Non-susceptibility to at least one agent in three or more antimicrobial categories.

Question 3

Define XDR.

Answer 3

Non-susceptibility to at least on agent in all but two or fewer antimicrobial categories.

Question 4

Define PDR.

Answer 4

Non-Susceptibility to all agents in all antimicrobial categories.

Question 5

Evidence that antibacterial cause resistance.

Answer 5

Laboratory evidence
Ecological studies relates levels of antibacterial use in a population with levels of resistance.
Individual level data

Question 6

IDSA definition of antimicrobial stewardship. (The objectives of it)

Answer 6

Appropriate use of antimicrobials
Optimal clinical outcome
Minimise toxicity and other adverse effects
Reduce cost of healthcare for infections
Limit the selection for antimicrobial resistant strains.

Question 7

Give the three main types of stewardship intervention.

Answer 7

Persuasive
Restrictive
Structural

Question 8

Explain persuasive stewardship intervention.

Answer 8

Educate
Consensus
Opinion leaders
Reminders
Audit
Feedback

Question 9

Explain restrictive stewardship intervention.

Answer 9

Restricted susceptibility reporting
Formulary restriction
Prior authorisation
Automatic stop orders

Question 10

Explain structural stewardship intervention.

Answer 10

Computersised records
Rapid lab tests
Expert systems
Quality monitoring

Question 11

Requirements for successful stewardship.

Answer 11

Long term confirmed and appropriate resources
Hospital leadership support
Integration into patient safety and quality of care structure/processes.