Antimicrobial Resistance Flashcards
What are the different levels of antimicrobial resistance?
Multi-drug resistant (MDR) = non-susceptibility to at least one agent in 3+ antimicrobial categories
Extensively drug resistant (XDR) = non-susceptibility to at least one agent in all but 2 or fewer antimicrobial categories
Pan-drug resistant (PDR) = non-susceptibility to all agents in all antimicrobial categories
What are some of the consequences of antimicrobial resistance?
Treatment failure
Prophylaxis failure (required for surgery, chemotherapy, immunosuppressed)
Economic costs (have to use newest and most expensive antibiotics)
Who is involved in antimicrobial stewardship, and what are the benefits?
Medical microbiologist, antimicrobial pharmacist, infection control nurse, hospital epidemiologist, information system specialist
Appropriate use of antimicrobials will:
- optimise clinical outcomes
- minimise toxicity and other adverse events
- reduce the costs of healthcare for infections
- limit the selection of antimicrobial resistant strains
What are the different forms of intervention in antimicrobial stewardship?
PERSUASIVE = education, consensus, opinion leaders, reminders, audit, feedback
RESTRICTIVE = restricted susceptibility reporting, formulary restriction, prior authorisation, automatic stop orders
STRUCTURAL = computerised records, rapid lab tests, expert systems, quality monitoring
How can the effectiveness of antimicrobial stewardship be assessed?
PROCESS MEASURES:
Comparison of antimicrobial use against other institutions
e.g. quality (defined daily does/1000 bed days), antimicrobial classes, appropriateness
OUTCOME MEASURES:
- patient outcomes
- emergence of resistance
- infection rate e.g. of C. difficile
Give some examples of antimicrobial-resistant infections.
MRSA (meticillin resistant Staphylococcus aureus)
Drug resistant C. difficile
VRE (vancomycin resistant enterococci)
ESBL (extended spectrum beta-lactamases)
