Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Immunology > stewardship > Flashcards

stewardship Flashcards

1
Q

What is antimicrobial stewardship?

A

promoting the selection of optimal drug regimen to improve and measure the appropriate use of antibiotics
- dosing, duration, route of administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Goals of antimicrobial stewardship

A
  1. optimize outcomes of abx use
  2. minimize toxicity/ADR
  3. reduce costs for infx
  4. limit the selection for resistant strains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Abx overuse and misuse

A
  1. unnecessary use
  2. wrong dose
  3. wrong drug
  4. excessive duration of therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

abx threat: urgent

A

Gram neg:
CRA
CRE (klebsiella, enterobacter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

abx threat: serious

A

ESBL producing enteroacteriales (K,E)
VRE
MDR Pseudomonas aeruginosa
MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Low threshold for abx prescribing

A
  1. perceived as non-toxic
  2. lack appropriate de-escalation
  3. suboptimal regimens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Consequences of inappropriate abx therapy: patient

A
  1. inadequate tx
  2. ADR
  3. Allergic rxn
  4. Superinfections/abx resistance/selection of problematic pathogens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Consequences of inappropriate abx therapy: society

A
  1. collateral damage (abx resistance)
  2. increased healthcare costs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Benefits of antimicrobial stewardship

A
  1. improved pt outcomes
  2. decreased ADR (C.diff diarrhea)
  3. ABX maintain susceptibility
  4. resource optimization
  5. reduced healthcare cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Broad spectrum agents: gram-positive

A
  1. Vanco
  2. Linezolid
  3. Dapto
  4. Ceftaroline
  5. Clindamycin
  6. Bactrim
  7. Doxycycline
    etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Broad spectrum agents: gram-negative

A
  1. piperacillin/tazobactam
  2. Cefepime
  3. Ceftazidime +/- Avibactam
  4. Ceftolozane/tazobactam
  5. Cefiderocol
  6. Carbapenems
  7. Aminoglycosides
  8. Fluoroquinolones
  9. Aztreonam
  10. Polymyxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

7 core elements of hospital ASP

A
  1. Hospital leadership commitment
  2. accountability
  3. pharmacy expertise
  4. action
  5. tracking
  6. reporting
  7. education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Regulation of ASP

A
  1. Joint Commission
  2. CMS (government)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacy-based stewardship interventions

A
  1. document indications
  2. IV to PO switch
  3. Dose adjust/optimization
  4. Use the most narrow spectrum drug to properly treat infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treating infection

A
  1. Empiric tx
  2. Definitive tx - after C/S, use narrow spectrum drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Empiric tx

A

Target most likely pathogen using antibiogram
consider: recent abx use, pt specific factors, local resistance patterns for institution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Definitive tx

A

C/S results available, de-escalate to narrow spectrum drug based on ability of drug to reach site of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Drugs of choice for: MSSA

A

Penicillins (NOD)
- Nafcillin, Oxacillin, Dicloxacillin
1st gen Cephalosporins (faz, pha)
- Cefazolin, Cephalexin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Drugs of choice for: MRSA

A

Hospital-acquired: IV
- Vanco
- Linezolid
- Dapto
- Ceftaroline (5th gen)
Community-acquired: any of above and PO
- clindamycin
- Bactrim
- Doxycycline

20
Q

Drugs of choice for: Streptococci

A

Penicillins
Cephalosporins
Vancomycin
Respiratory Fluoroquinolones
- moxifloxacin, levofloxacin

21
Q

Drugs of choice for: Enterococci

A

Ampicillin
Vancomycin
Linezolid
Daptomycin

22
Q

LAME organisms

A

L = listeria
A = acinetobacter
M= MRSA (ceftaroline covers)
E= enterococcus
NOT covered by cephalosporins

23
Q

Drugs of choice for: Pseudomonas

A

Beta lactams
- pip/tazo
- Ceftozolane/tazo
- ceftazidime/avibactam
- ceftazidime
- cefiderocol
- carbapenems (not ertapenem)
Non-beta lactams
- Fluoroquinolones (not moxifloxacin)
- Aminoglycosides (amikacin>tobramycin>gentamicin)

24
Q

Acinetobacter

A

Requires susceptibility tests
Carbapenems (not ertapenem)
- Meropenem
- Imipenem/cilastatin
Ampicillin/sulbactam
Cefiderocol

25
Q

Ertapenem lacks coverage of APE organisms

A

Acinetobacter
Pseudomonas
Enterococcus

26
Q

Penicillin-ase

A

Amox/clav
Amp/sulbactam
Pip/tazo

27
Q

ESBL-ase

A

Carbapenems
pip/tazo

28
Q

CRE-ase

A

Ceftazidime/avibactam
Meropenem/vaborbactam
Imipenem/Cilastatin/relebactam
Cefiderocol

29
Q

Cephalo-ase

A

Carbapenem
Non-BL agents

30
Q

Oral Anaerobes

A

peptostreptococcus, prevotella

31
Q

Oral Anaerobe tx

A

Clindamycin
penicillin
—
Moxifloxacin
Amp/sulbact
Amox/clav
pip/tazo
carbapenems

32
Q

Intestinal anaerboes

A

Bacteroids (b.fragilis), clostridium

33
Q

Intestinal anaerobe tx

A

Moxifloxacin
Amp/sulbact
Amox/clav
pip/tazo
carbapenems
penicillin

34
Q

Clostridium difficile treatment

A

Fixaxomicin PO
Vancomycin PO
Metronidazole IV for fullminant

35
Q

3rd gen cephalosporin cautioned use with

A

HECK YES organisms
due to inducible ampC

36
Q

HECK YES organisms

A

Hafnia alvei
*Enterobacter cloacae
*Citrobacter freundii
*Klebsiella aerogenes
YerSinia enterocolitica

*most problematic organisms that induce ampC (8-40% initially S –> R in a few days)

37
Q

Drugs to treat HECK YES

A
  1. Cefipime
  2. Piperacillin/Tazobactam (maybe)
  3. carbapenems
    avoid ceftriazone unless uncomplicated cystitis
38
Q

Methods for stewardship

A
  1. time sensitive automatic stop order
  2. PCN allergy assessment
  3. Detection/prevention DDI
  4. Formulary restiction/preauthorization
39
Q

Less common AmpC inducers

A

Halfnia alvei
Citrobacter youngae
Yersinia enterocolitica

40
Q

risk <5% AmpC inducers

A

Serratia marcenscens
Morganella mrganii
providencia

41
Q

Formulary restriction/Preauthorization

A

Helps decrease abx use, resistance (gram negative primarily), and cost
Examples of formulary restriction
Daptomycin
Micafungin
Linezolid
Coritavancin
Tigecycline
Amphotercin B
Meropenem
Ertapenem
Ceftaroline

42
Q

PCN allergy assessment

A

Differentiate between severe vs non-severe reactions
- 10-30% patients report PCN allergy but only 10% documented are true IgE T1HS rxns
Check how long ago the reaction was
- IgE antibodies decrease over time
want to keep PCN a viable option because first line, less costly, better ADR profile

43
Q

Management of PCN allergy

A

Review prior abx use, check for hx of tolerance
Assess R1 side chain
Skin test to confirm allergy
update allergy profile

44
Q

Low cross-reactivity between PCN and beta lactams

A

0.17-8.4% Cephalosporins (1st>3rd)
0.3-4.3% Carbapenems
None: Aztreonam

45
Q

Caution use of aztreonam with which 2 cephalosporins due to same R1 side chain

A

caution if allergy to
Cefazidime
Cefiderocol

46
Q

Alternative agents for severe PCN allergy

A

Vancomycin
Fluoroquinolones
Clindamycin
Aztreonam

47
Q

Why do we want to avoid using alt agents

A

increased costs
increased risk for MDR organisms
Increased risk for ADR

Immunology (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions