Define antimicrobial stewardship
Appropriate use of antibiotics in order to optimise clinical outcomes minimise unitended consequences of antimicrobial use (toxicity, selection of pathogenic or resistance organisms)
Why is antiimicrobial stewardship important
Effect on patients: Clinical outcome, length of stay, Hospital acquired infections
Effect on hospitals: Bed management, morbidity/mortality, cost
Effect on the NHS: Cost, resistance
Name 3 healthcare associated infections associated with antibiotic use
C. difficile - ciprofloxacin
MRSA - flucloxacin, broad-spectrum penicillins
ESBL - broad-spectrum penicillins
VRE - use of vancomycin in renal units
Key things to take into account when deciding whether or not to prescribe an antibiotic?
Appropriate route of administration
Source of infection
Need for senior advice
When prescribing an antibiotic, what must you include on the kardex?
Indication for use, drug, dose, administration, review date
How soon should you start antibiotics in a patient with life-threatening illness?
Within the first hour
Responsibility of the Dr who first sees the patient to administer the first IV dose.
N.B. Cultures taken first!
When shoud IV antibiotic administration be reviewed?
Switch to oral, narrrow spectrum or OPAT (outpatient, parenteral antibiotic)
Factors that lead to increased risk of resistance
Inappropriate use of antibiotics
Poor infection control
Excessive antiiotic use in non-clinical settings
Give three examples of how antibiotics lead to HAIs (describe)
C. diff: prolonged use of antibiotics disrupts the normal flora allowing colonisation of C.diff leading to diarrhoea
MRSA: normal flora eradicated allowing colonisation of the skin with MRSA which can go on to cause infection
ESBL: following broad spectrum antibiotic use strainsa re selected out and persist, can cause infection
When are antibiotics used prophylactically?
Given to prevent infection before surgery (e.g. graft/prosthesis, dirty operation - pus, bowel contents)
In patients prone to particular infections
In patients who are specifically immunocompromised
Antibiotics are targetted to the most likely pathogens, duration kept to a minimum to reduce the chance of resitance
What is targeted antibiotic therapy?
Wen the infection and causative organism are known
Best way of effective treatment because the sensitivity of the pathogen can be determined
What is empiracal antibiotic therapy?
Antibiotic given without knowing the causative organism
Choice basd on practical experience, EBM. Therapy used to cover all possibilities until cause is determined.
Antibiotics which are not excreted in the urine
Standard infection control precautions
Safe use of Sharps
Clinical Waste Disposal
Prevention of C. difficile infections in hospital
Reduce antibiotic use generally
Reduce specific antibiotics (cephalosporins and ciprofloxacin)
Isolate infectious patients
Treat infected patients to reduce diarrhoea
Clean the environment