Antimicrobial resistance and stewardship

Question 1

what are antibiotics used for?

Answer 1

surgery prophylaxis
chemotherapy prophylaxis?
bacterial pneumonia

Question 2

what are antibiotics not used for?

Answer 2

most throat infections
parasitic infections
influenza

Question 3

is resistance a normal function?

Answer 3

yes, always some in the gut but don’t cause an issue

only cause problem when they get into sterile site

Question 4

what is the clinical vs laboratory phenomenon of AMR?

Answer 4

Lab
- grow bacteria on petri dish
- dot antimicrobial on dish to see if it inhibits growth
Clinical
- bacteria grow and proliferate causing disease

Question 5

what are the 4 types of resistance?

Answer 5

resistance = lab confirmed resistance to 1 antibiotic agent
MDR = non-susceptibility to at least 1 agent in 3 or more antimicrobial categories
XDR =
PDR =

Question 6

is AMR usually innate or acquired?

Answer 6

acquired

Question 7

what things could make normal asymptomatic resistant bacteria in the gut become dangerous?

Answer 7

change in diet
illness (bacteria can get into sterile site)
antibiotic treatment

Question 8

how does AMR spread through bacteria at times of vulnerability?

Answer 8

mutation (vertical transfer)
explode releasing resistant genetic material
phage viruses take gene from one bacteria to another (transduction)
release genetic material through plasmates into susceptible bacteria

Question 9

name 6 resistance mechanisms

Answer 9

Efflux
Impermeability
Inactivation
Altered target
Pbps
By-pass

Question 10

where is high resistant E coli most common?

Answer 10

southern European countries (as they prescribe more antibiotics)

Question 11

what are the 2 largest drivers of AMR?

Answer 11

human antimicrobial misuse

animal antimicrobial misuse

Question 12

what are some clinical and economical consequences of not prescribing antibiotics?

Answer 12

not treating wont kill but takes much longer for infection to heal so more GP visits etc

Question 13

where is growth in antimicrobial use the highest?

Answer 13

middle income countries

Question 14

where does most prescription occur?

Answer 14

community

Question 15

what are the 4 Ds of AMS?

Answer 15

drug
dose
duration
de-escalation

Question 16

what are the 4 goals of AMS?

Answer 16

improve patient care
reduce costs
reduce resistance, C. diff, toxicity

Question 17

what are some drivers for AMR?

Answer 17

unnecessary antibiotics
excessive amount
too broad spectrum
Too long duration
underdosing

Question 18

what are some drivers for C. Diff infection?

Answer 18

quinolones
cephlasporins
too long duration
too many antibiotics

Question 19

is ceftriaxone broad spectrum?

Answer 19

yes

Question 20

is it important to switch from IV to oral antibiotics ASAP?

Answer 20

yes