Week 7: Antimicrobial Resistance and Antimicrobial Stewardship Flashcards
1
Q
What controls the movement of substances in and out of the cell?
A
The cell membrane
2
Q
Do prokaryotes have a nucleus?
A
No
3
Q
Are bacteria prokaryotic or eukaryotic?
A
Prokaryotic
4
Q
Bacteria have different ____ from eukaryotic cells and unique ____ _____
A
ribosomes; cell walls
5
Q
Bacteria have one long circular molecule of double-stranded DNA. This is called the ___ and is attached to the ___ ____
A
bacterial chromosme; plasma membrane
6
Q
In addition to the bacterial chromosome, bacteria also often contain double-stranded DNA molecules called what?
A
Plasmids
7
Q
What are the 3 cocci?
A
-staphlococci
-diplococci
-streptococci
8
Q
What are the 2 types of bacilli?
A
-streptobacilli
-diplobacilli
9
Q
What is the cell wall and outer membrane of a gram negative bacteria composed of?
A
peptidoglycan; phospholipids lipopropteins, lipoprolysacchrides
10
Q
One of the most used types of therapeutic drugs is what?
A
antimicrobials
11
Q
What are the 2 basic mechanisms of bacterial resistance?
A
- Genetic mutations with selective pressure (used to bypass threats)
- Horizontal gene transfer: knowledge passed on to future generations
12
Q
What is the tool used by ICPs to determine the status of multi-drug resistant pathogens
A
antibiograms
13
Q
what are 3 examples of antimicrobials
A
- antibiotics
- antifungals
- antivirals
14
Q
Define antimicrobial resistance
A
the ability of microorganisms to overcome antimicrobials
15
Q
define multidrug resistant organisms
A
resistant to multiple classes of antimicrobial agent
16
Q
define antimicrobial stewardship
A
program designed to improve/optimize antimicrobial selection, dose, and duration
17
Q
what are the 2 mechanisms of action by antimicrobials?
A
- cidal-kills (kills >99%)
- static=slows or inhibits growth (kills 90-99%)
18
Q
What are 2 characteristics that impact the effectiveness of antimicrobials?
A
1.minimal inhibitory concentration
2. half-life
19
Q
define minimal inhibitory concentration (MIC)
A
Lowest drug concentration that inhibits microbial growth
20
Q
define half-life
A
period a body requires to metabolize half of the drug
21
Q
What is recommended for drugs that cause concentration-dependent activity
A
shorter usage with higher concentration
22
Q
What is recommended for drugs with time dependent activity?
A
increased frequency at lower dose
23
Q
What is an example of a drug that should be maintained above the MIC?
A
B-lactams
24
Q
All penicillins, cephlosporins, monoactams, and carbapenems contain what?
A
a B-lactam ring
25
All B-lactam drugs possess bactericidal activity by doing what?
Inhibiting cell wall synthesis
26
What is one of the most used antibiotics of all time?
Penicillin
27
What is the drug of choice for treatment of group A streptococcal pharyngitis and other infections caused by this pathogen
natural peniccilin
28
natural penicillins also have activity against what?
-anaerobic bacteria found in the human mouth
-enterococci
-most streptococcal species
29
How many generations of cephlosporins are there?
5
30
what does ertapenem not treat?
resistant gram-negative bacilli like P. aureginosa or Acinetobacter
31
What is used if people are allergic to penicillin?
Ciproflaxacin
32
What are levofloxacin and moxifloxacin used to treat?
community-acquired pneumonia, S. pneumoniae, Legionella
33
What are Azithromycin and Clarithromycin used to treat?
Legionella, mycoplasma, and chlamydia
34
Which drug has limited spectrum activity and therefore is used to mostly treat less serious community-acquired infections?
macrolides
35
What drug is used for serious or multi-drug resistant gram-negative infections?
Aminoglycosides
36
What drug is used for latent or active TB?
rifampin or rifabutin
37
what is used as proxphalxis for people with expoure to meningitis?
rifampin
38
how does vancomycin work?
inhibits cells wall and cell membrane synthesis
39
Vancomycin is bactericidal against what m.o.?
-streptococcus
-entercoccus
-staphlococcus
40
What is used to treat the family of viruses herpesviridae?
acyclovir
41
What is the treatment for herpes type 1 and 2?
valacicovir and famciclovir
42
What is used to treatment cytomegalovirus?
ganciclovir and valganciclovir
43
Gangciclovir and valganciclovir are associated with what?
Bone marrow toxicity
44
interferons stimulate the patients immune system an are used for what?
Hep B, C, herpes, and papillomavirus
45
What drug is used in transplant patients with severe respiratory syncytial virus?
ribavirin
46
Antiretrovirals and ART are used for patients with what?
HIV
47
What does antiretroviral therapy do?
uses a combination of various drugs that act in combination to suppress viral replication effectively
48
What are 4 indictions for antimicrobial use?
-prophylatic
-pre-emptive
-empiric
-definitive
49
what does prophylatic mean?
used to prevent infections
50
what does pre-emptive mean?
used to abort infections
51
what does empiric mean?
used to provide initial control of infection in absence of knowledge of its etiology
52
what does definitive mean?
used to definitively cure infection of a known etiology or its antimicrobial susceptibility
53
Antimicrobial use designed to prevent infection is deemed to be what?
prophylactic
54
when is surgical antimicrobial propphylaxis recommended?
when risk of wound infection is high
55
When is empirical therapy commonly used?
in the hospital when waiting for culture and sensitivity results
56
the choice of empiric therapy depends on what?
host factors and the site of infection
57
What therapy is used when the pathogen has been determined?
pathogen-directed therapy
58
PCR tests are used for what m.o.?
-TB
-Gonorrhea
-Chlmydia
-C. diff
59
What are the 5 major factors that contribute to successful antimicrobial therapy?
1. prompt treatment
2. virulence and susceptibility of the infecting organism
3. activity of the antimicrobial at a particular site of infection
4. condition and immunocompetence of the patient
5. certain body sites (heart valves) are more difficult to treat
60
In addition to choosing the most appropriate antimicrobial, what else must be selected to improve outcomes?
-appropriate dose
-route of adminstration
61
doses must be ___ to be therapeutic and kill the microorganism and __ not to be toxic
high;low
62
Does infection site affect the use of antibiotics?
Yes (i.e., CNS requires increased dosage while UTI requires decreased)
63
Antibiograms are used to guide choice of what? what do they track?
empiric therapy; resistance patterns
64
antibiograms answer questions in what two main areas?
1. clinical care
2. IPAC strategies
65
How often should the antibiogram be generated?
at least annually with a minimum of 30 isolates
66
can isolates be taken from colonizations for antibiograms?
No-only actual infection sites
67
an antibiogram should include what?
a table with pathogens with the total number of isolates listed against antimicrobials
68
what is the rule for using or not use an antibiotic according to the antibiogram?
-80+ is a go
-red=no
69
how much does AMR cost the Canadian GDP annually?
2 billion
70
By 2050, it is predicted that AMR will reduce the Canadian GDP by how much annually?
21 billion
71
in 2018, how many Canadians lost their lives to AMR
5,400
72
with an E-test or D-test, what indicates not a good choice of antibiotic?
growth closer to the antibiotic
73
What is a good-sign with microtiter (broth dilution)
when you have clearance/it stops growing
74
p. aeroginosa is resistant to what?
carbapenems
75
describe how metabolic pathways of a mechanism of antimicrobial rsistance
bypass the pathway that was inhibited by the antimicrobial
76
describe drug inactivation (antimicrobial resistance)
bacterium produces an enzyme (like B-lactamase enzymes that destroy or inactivate the penicillins and cephlosporins)
77
What is antimicrobial resistance the result of?
pooint mutations in existing genes or the acquisition of new genes
78
what are point mutations?
random errors that occur during DNA replication
79
when did VRE become resistant?
1980
80
When did Candida become resistant?
1990
81
when did ESBL become resistant?
1990
82
what are one of the top public health achievements in the 20th century?
miracle drugs
83
what are some components of the antimicrobial stewardship program?
-leadership commitment
-accountability
-drug expertise
-action
-tracking
-reporting
-education
84
can resistantance develop within a short time?
Yes
85
Methicillin resistance was discovered how many years after methicillin was introduced?
2 years
86
How many illnesses and deaths occur yearly in the USA due to AMR?
2 million illnesses; 23,000 deaths
87
In Canada, how many infections were preventable if the infection was susceptible to first line antimicrobials?
4 in 10 cases
88
In Canada in 2018, how many bacterial infections were there and how many were resistant? How many deaths did this result in?
980,000 infections; 250,000 resistant infections with 14,000 deaths
89
It is estimated that by 2050, the rate of resistance is estimated to grow by?
40%
90
True or false. One component of the ASP will be optimizing selections, dosage, and duration of treatment to produce best outcome and minimal toxicity
True
91
antimicrobials are associated with _ of hpsitalized patients experiencing an adverse event
less than 20%
92
antimicrobials have been associated with various patient safety events such as
-deaths
-adverse drug reactions
-drug interactions
-cross sensitivity of drugs
93
microbiome alterations have been associated with (antimicrobial use and patient safety)
autoimmune syndromes in the pediatric population
94
Clindamycin, peniccilin, doxyclcine, quinolones, and macrolides are linked to
congenital defects
95
How many ER visits each year are due to antimicrobial adverse events?
140,000
96
__ in ___ ER visits due to an adverse drug reactions is caused by an antimicrobial
1 in 5
97
targeted reduction of broad-spectrum antimicrobial has been assocaited with a decrease in
CDI rates
98
Define antimicrobial stewardship
the coordination of programming efforts designed to improve antimicrobial use by optimizing the dose, duration, and route of adminstration
99
The primary clinical experts for antimicrobial stewardship are
ID docs and pharmacists
100
What are 4 goals of antimicrobial stewardship?
1. slow the emergence of resistant bacteria and prevent the spread of resistant infections
2. Use of rapid and innovative diagnostic tests for identifcation of resistant bacteria
3. accelrate devlopment of new antibiotics/vaccines
4. improve international collaboration for antibotic resistance, research development, etc/
101
What are some set requirements for AMS in the USA?
-by 2019 each LTC home had to have an ICP to support ASP
-hospitals had to have an AMR to reduce adverse outcomes like CDI
-patient education is required for nursing care centres
102
describe leadership commitment (ASP)
dedicating necessary resources
103
describe accountability (ASP)
appointing a single leader to be responsible for program outcomes
104
describe drug expertise (ASP)
appointing a single pharmacist leader responsible for working to improve antibiotic use
105
describe action (ASP)
implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment
106
describe tracking (ASP)
monitoring antibiotic prescribing and resistance patterns
107
describe reporting (ASP)
regular reporting information on antibiotic use and resistance to relevant staff
108
describe education (ASP)
educating clinicians about resistance and optimal prescribing
109
what are the 3 components of action (ASP)
1. Preauthorization
2. Prospective Audit and Feedback (PAF)
3. Diagnostic stewardship
110
describe preauthorization (action-ASP)
requires the ordering clinician to obtain approval from ID physician or pharmacists for use of an antimicrobial
111
describe PAF (action-ASP)
is completed 48-72 hours post initial order. Order is reviewed to determinate if drug change is recommended
112
describe diagnostic stewardship (ASP)
a complementary process used for rapdi detection and identificaion of organismss and the need for an integrated model between IAPC, ASP, and diagnostic stewardshipq
113
what are the 3 components of tracking?
-DOT (days of therapy)
-LOT (length of therapy)
-Defined Daily Dose (DDD)
114
what is DOT used to assess?
used to assss antimicrobial use and track changes in prescribing
115
what is DDD
the assumed average maintenance dose per day
116
what are the 2 components of reporting?
process and outcome measures
117
describe process measures
days of unecessary antimicrobial therapy, duration of therapy, compliance with treatment guidelines, proportion of patients not receiving the correct antimicrobial
118
describe outcome measures
include patient outcomes (length of hospital stay, hospital readmission, acquired CDI, 30-day mortality)
119
In Canada in 2016, approximately __ more antimicrobials were used in animals than humans
1.5 times
120
Which province has the highest antimicrobial use?
Newfoundland and Labrador
121
In 2015, people in Canada filled more than __ prescriptions for antibiotics
25 million
122
True or false. Medically important antimicrobials cannot be used as growth promoters
True
123
True or false. Accreditation Canada requires hospitals to have an ASP
TRUE :)
124
What are some priority level A ASP strategies?
-antibiograms
-dose optimization
-formulary restriction
-prescriber education
-therapuetic drug monitoring
125
What are some priority level B ASP strategies?
-chechlists
-de-escelation and streamlining
-disease-specific treatment guidelines
-strategic microbioogy results reporting
-drug use evaluation
126
What are some priority level C strategies?
-automatic stop orders
-clinical decision support systems/computerized physician order entry
-improved diagnostics
-general antimicrobial order forms
