Infection - Antibiotic Stewardship Flashcards
Give some general consequences of antibacterial resistance
- treatment failure
- prophylaxis failure
- economic costs
What does it mean when bacteria is described as MDR?
Multi-drug resistant - non-susceptibility to at least one agent in three or more antimicrobial categories
What does it mean when bacteria is described as XDR?
Extensively drug resistant - non-susceptibility to at least one agent in all but 2 or fewer antimicrobial categories
What does it mean when bacteria is described as PDR?
Pan-drug resistant - non-susceptibility to all agents in all antimicrobial categories
What is meant by the antibiotic ‘discovery void’?
The lack of new discoveries of antibiotic classes since the 1980s
Give some types of evidence that antibacterial use causes resistance
- laboratory evidence (provides biological plausibility)
- ecological studies (relate levels of antibacterial use in a population with levels of resistance)
- individual level data (relates prior antibacterial use in an individual with subsequent presence of bacterial resistance)
What are the objectives of the IDSA definition of antimicrobial stewardship?
- appropriate use of antimicrobials
- optimal clinical outcomes
- minimise toxicity and other adverse events
- reduce costs of health care for infections
- limit selection for antimicrobial resistant strains
Which members of a multi-disciplinary team are key in enforcing antimicrobial stewardship?
- medical microbiologist/infectious diseases physician
- antimicrobial pharmacist
- infection control nurse
- hospital epidemiologist
- information system specialist
What are the three types of stewardship interventions?
- persuasive
- restrictive
- structural
What are the key elements of persuasive stewardship?
Education, consensus, opinion leaders, reminders, audit, feedback
What are the key elements of restrictive stewardship?
Restricted susceptibility reporting, formulary restriction, prior authorisation, automatic stop orders
What are the key elements of structural stewardship?
Computerised records, rapid lab tests, expert systems, quality monitoring
What are the measures of successful stewardship?
- patient outcomes
- emergence of resistance
- C. difficile infection rate
What are the requirements for successful stewardship?
- long-term confirmed and appropriate resources
- hospital leadership support and delegated authority to challenge/change inappropriate antimicrobial use
- integration into organisational patient safety and quality of care structure and processes
