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Infection control > Week 7: Antimicrobial Resistance and Antimicrobial Stewardship > Flashcards

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

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2
Q

Do prokaryotes have a nucleus?

A

No

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3
Q

Are bacteria prokaryotic or eukaryotic?

A

Prokaryotic

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4
Q

Bacteria have different ____ from eukaryotic cells and unique ____ _____

A

ribosomes; cell walls

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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

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6
Q

In addition to the bacterial chromosome, bacteria also often contain double-stranded DNA molecules called what?

A

Plasmids

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7
Q

What are the 3 cocci?

A

-staphlococci
-diplococci
-streptococci

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8
Q

What are the 2 types of bacilli?

A

-streptobacilli
-diplobacilli

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9
Q

What is the cell wall and outer membrane of a gram negative bacteria composed of?

A

peptidoglycan; phospholipids lipopropteins, lipoprolysacchrides

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10
Q

One of the most used types of therapeutic drugs is what?

A

antimicrobials

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11
Q

What are the 2 basic mechanisms of bacterial resistance?

A
  1. Genetic mutations with selective pressure (used to bypass threats)
  2. Horizontal gene transfer: knowledge passed on to future generations
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12
Q

What is the tool used by ICPs to determine the status of multi-drug resistant pathogens

A

antibiograms

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13
Q

what are 3 examples of antimicrobials

A
  1. antibiotics
  2. antifungals
  3. antivirals
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14
Q

Define antimicrobial resistance

A

the ability of microorganisms to overcome antimicrobials

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15
Q

define multidrug resistant organisms

A

resistant to multiple classes of antimicrobial agent

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16
Q

define antimicrobial stewardship

A

program designed to improve/optimize antimicrobial selection, dose, and duration

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17
Q

what are the 2 mechanisms of action by antimicrobials?

A
  1. cidal-kills (kills >99%)
  2. static=slows or inhibits growth (kills 90-99%)
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18
Q

What are 2 characteristics that impact the effectiveness of antimicrobials?

A

1.minimal inhibitory concentration
2. half-life

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19
Q

define minimal inhibitory concentration (MIC)

A

Lowest drug concentration that inhibits microbial growth

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20
Q

define half-life

A

period a body requires to metabolize half of the drug

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21
Q

What is recommended for drugs that cause concentration-dependent activity

A

shorter usage with higher concentration

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22
Q

What is recommended for drugs with time dependent activity?

A

increased frequency at lower dose

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23
Q

What is an example of a drug that should be maintained above the MIC?

A

B-lactams

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24
Q

All penicillins, cephlosporins, monoactams, and carbapenems contain what?

A

a B-lactam ring

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25
Q

All B-lactam drugs possess bactericidal activity by doing what?

A

Inhibiting cell wall synthesis

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26
Q

What is one of the most used antibiotics of all time?

A

Penicillin

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27
Q

What is the drug of choice for treatment of group A streptococcal pharyngitis and other infections caused by this pathogen

A

natural peniccilin

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28
Q

natural penicillins also have activity against what?

A

-anaerobic bacteria found in the human mouth
-enterococci
-most streptococcal species

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29
Q

How many generations of cephlosporins are there?

A

5

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30
Q

what does ertapenem not treat?

A

resistant gram-negative bacilli like P. aureginosa or Acinetobacter

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31
Q

What is used if people are allergic to penicillin?

A

Ciproflaxacin

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32
Q

What are levofloxacin and moxifloxacin used to treat?

A

community-acquired pneumonia, S. pneumoniae, Legionella

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33
Q

What are Azithromycin and Clarithromycin used to treat?

A

Legionella, mycoplasma, and chlamydia

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34
Q

Which drug has limited spectrum activity and therefore is used to mostly treat less serious community-acquired infections?

A

macrolides

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35
Q

What drug is used for serious or multi-drug resistant gram-negative infections?

A

Aminoglycosides

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36
Q

What drug is used for latent or active TB?

A

rifampin or rifabutin

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37
Q

what is used as proxphalxis for people with expoure to meningitis?

A

rifampin

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38
Q

how does vancomycin work?

A

inhibits cells wall and cell membrane synthesis

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39
Q

Vancomycin is bactericidal against what m.o.?

A

-streptococcus
-entercoccus
-staphlococcus

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40
Q

What is used to treat the family of viruses herpesviridae?

A

acyclovir

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41
Q

What is the treatment for herpes type 1 and 2?

A

valacicovir and famciclovir

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42
Q

What is used to treatment cytomegalovirus?

A

ganciclovir and valganciclovir

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43
Q

Gangciclovir and valganciclovir are associated with what?

A

Bone marrow toxicity

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44
Q

interferons stimulate the patients immune system an are used for what?

A

Hep B, C, herpes, and papillomavirus

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45
Q

What drug is used in transplant patients with severe respiratory syncytial virus?

A

ribavirin

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46
Q

Antiretrovirals and ART are used for patients with what?

A

HIV

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47
Q

What does antiretroviral therapy do?

A

uses a combination of various drugs that act in combination to suppress viral replication effectively

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48
Q

What are 4 indictions for antimicrobial use?

A

-prophylatic
-pre-emptive
-empiric
-definitive

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49
Q

what does prophylatic mean?

A

used to prevent infections

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50
Q

what does pre-emptive mean?

A

used to abort infections

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51
Q

what does empiric mean?

A

used to provide initial control of infection in absence of knowledge of its etiology

52
Q

what does definitive mean?

A

used to definitively cure infection of a known etiology or its antimicrobial susceptibility

53
Q

Antimicrobial use designed to prevent infection is deemed to be what?

A

prophylactic

54
Q

when is surgical antimicrobial propphylaxis recommended?

A

when risk of wound infection is high

55
Q

When is empirical therapy commonly used?

A

in the hospital when waiting for culture and sensitivity results

56
Q

the choice of empiric therapy depends on what?

A

host factors and the site of infection

57
Q

What therapy is used when the pathogen has been determined?

A

pathogen-directed therapy

58
Q

PCR tests are used for what m.o.?

A

-TB
-Gonorrhea
-Chlmydia
-C. diff

59
Q

What are the 5 major factors that contribute to successful antimicrobial therapy?

A
  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
Q

In addition to choosing the most appropriate antimicrobial, what else must be selected to improve outcomes?

A

-appropriate dose
-route of adminstration

61
Q

doses must be ___ to be therapeutic and kill the microorganism and __ not to be toxic

A

high;low

62
Q

Does infection site affect the use of antibiotics?

A

Yes (i.e., CNS requires increased dosage while UTI requires decreased)

63
Q

Antibiograms are used to guide choice of what? what do they track?

A

empiric therapy; resistance patterns

64
Q

antibiograms answer questions in what two main areas?

A
  1. clinical care
  2. IPAC strategies
65
Q

How often should the antibiogram be generated?

A

at least annually with a minimum of 30 isolates

66
Q

can isolates be taken from colonizations for antibiograms?

A

No-only actual infection sites

67
Q

an antibiogram should include what?

A

a table with pathogens with the total number of isolates listed against antimicrobials

68
Q

what is the rule for using or not use an antibiotic according to the antibiogram?

A

-80+ is a go
-red=no

69
Q

how much does AMR cost the Canadian GDP annually?

A

2 billion

70
Q

By 2050, it is predicted that AMR will reduce the Canadian GDP by how much annually?

A

21 billion

71
Q

in 2018, how many Canadians lost their lives to AMR

A

5,400

72
Q

with an E-test or D-test, what indicates not a good choice of antibiotic?

A

growth closer to the antibiotic

73
Q

What is a good-sign with microtiter (broth dilution)

A

when you have clearance/it stops growing

74
Q

p. aeroginosa is resistant to what?

A

carbapenems

75
Q

describe how metabolic pathways of a mechanism of antimicrobial rsistance

A

bypass the pathway that was inhibited by the antimicrobial

76
Q

describe drug inactivation (antimicrobial resistance)

A

bacterium produces an enzyme (like B-lactamase enzymes that destroy or inactivate the penicillins and cephlosporins)

77
Q

What is antimicrobial resistance the result of?

A

pooint mutations in existing genes or the acquisition of new genes

78
Q

what are point mutations?

A

random errors that occur during DNA replication

79
Q

when did VRE become resistant?

A

1980

80
Q

When did Candida become resistant?

A

1990

81
Q

when did ESBL become resistant?

A

1990

82
Q

what are one of the top public health achievements in the 20th century?

A

miracle drugs

83
Q

what are some components of the antimicrobial stewardship program?

A

-leadership commitment
-accountability
-drug expertise
-action
-tracking
-reporting
-education

84
Q

can resistantance develop within a short time?

A

Yes

85
Q

Methicillin resistance was discovered how many years after methicillin was introduced?

A

2 years

86
Q

How many illnesses and deaths occur yearly in the USA due to AMR?

A

2 million illnesses; 23,000 deaths

87
Q

In Canada, how many infections were preventable if the infection was susceptible to first line antimicrobials?

A

4 in 10 cases

88
Q

In Canada in 2018, how many bacterial infections were there and how many were resistant? How many deaths did this result in?

A

980,000 infections; 250,000 resistant infections with 14,000 deaths

89
Q

It is estimated that by 2050, the rate of resistance is estimated to grow by?

A

40%

90
Q

True or false. One component of the ASP will be optimizing selections, dosage, and duration of treatment to produce best outcome and minimal toxicity

A

True

91
Q

antimicrobials are associated with _ of hpsitalized patients experiencing an adverse event

A

less than 20%

92
Q

antimicrobials have been associated with various patient safety events such as

A

-deaths
-adverse drug reactions
-drug interactions
-cross sensitivity of drugs

93
Q

microbiome alterations have been associated with (antimicrobial use and patient safety)

A

autoimmune syndromes in the pediatric population

94
Q

Clindamycin, peniccilin, doxyclcine, quinolones, and macrolides are linked to

A

congenital defects

95
Q

How many ER visits each year are due to antimicrobial adverse events?

A

140,000

96
Q

__ in ___ ER visits due to an adverse drug reactions is caused by an antimicrobial

A

1 in 5

97
Q

targeted reduction of broad-spectrum antimicrobial has been assocaited with a decrease in

A

CDI rates

98
Q

Define antimicrobial stewardship

A

the coordination of programming efforts designed to improve antimicrobial use by optimizing the dose, duration, and route of adminstration

99
Q

The primary clinical experts for antimicrobial stewardship are

A

ID docs and pharmacists

100
Q

What are 4 goals of antimicrobial stewardship?

A
  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
Q

What are some set requirements for AMS in the USA?

A

-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
Q

describe leadership commitment (ASP)

A

dedicating necessary resources

103
Q

describe accountability (ASP)

A

appointing a single leader to be responsible for program outcomes

104
Q

describe drug expertise (ASP)

A

appointing a single pharmacist leader responsible for working to improve antibiotic use

105
Q

describe action (ASP)

A

implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment

106
Q

describe tracking (ASP)

A

monitoring antibiotic prescribing and resistance patterns

107
Q

describe reporting (ASP)

A

regular reporting information on antibiotic use and resistance to relevant staff

108
Q

describe education (ASP)

A

educating clinicians about resistance and optimal prescribing

109
Q

what are the 3 components of action (ASP)

A
  1. Preauthorization
  2. Prospective Audit and Feedback (PAF)
  3. Diagnostic stewardship
110
Q

describe preauthorization (action-ASP)

A

requires the ordering clinician to obtain approval from ID physician or pharmacists for use of an antimicrobial

111
Q

describe PAF (action-ASP)

A

is completed 48-72 hours post initial order. Order is reviewed to determinate if drug change is recommended

112
Q

describe diagnostic stewardship (ASP)

A

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
Q

what are the 3 components of tracking?

A

-DOT (days of therapy)
-LOT (length of therapy)
-Defined Daily Dose (DDD)

114
Q

what is DOT used to assess?

A

used to assss antimicrobial use and track changes in prescribing

115
Q

what is DDD

A

the assumed average maintenance dose per day

116
Q

what are the 2 components of reporting?

A

process and outcome measures

117
Q

describe process measures

A

days of unecessary antimicrobial therapy, duration of therapy, compliance with treatment guidelines, proportion of patients not receiving the correct antimicrobial

118
Q

describe outcome measures

A

include patient outcomes (length of hospital stay, hospital readmission, acquired CDI, 30-day mortality)

119
Q

In Canada in 2016, approximately __ more antimicrobials were used in animals than humans

A

1.5 times

120
Q

Which province has the highest antimicrobial use?

A

Newfoundland and Labrador

121
Q

In 2015, people in Canada filled more than __ prescriptions for antibiotics

A

25 million

122
Q

True or false. Medically important antimicrobials cannot be used as growth promoters

A

True

123
Q

True or false. Accreditation Canada requires hospitals to have an ASP

A

TRUE :)

124
Q

What are some priority level A ASP strategies?

A

-antibiograms
-dose optimization
-formulary restriction
-prescriber education
-therapuetic drug monitoring

125
Q

What are some priority level B ASP strategies?

A

-chechlists
-de-escelation and streamlining
-disease-specific treatment guidelines
-strategic microbioogy results reporting
-drug use evaluation

126
Q

What are some priority level C strategies?

A

-automatic stop orders
-clinical decision support systems/computerized physician order entry
-improved diagnostics
-general antimicrobial order forms

Infection control (7 decks)

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