Antibiotics, prescribing & infection control Flashcards

1
Q

Define antimicrobial stewardship

A

Appropriate use of antibiotics in order to optimise clinical outcomes minimise unitended consequences of antimicrobial use (toxicity, selection of pathogenic or resistance organisms)

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2
Q

Why is antiimicrobial stewardship important

A

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

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3
Q

Name 3 healthcare associated infections associated with antibiotic use

A

C. difficile - ciprofloxacin

MRSA - flucloxacin, broad-spectrum penicillins

ESBL - broad-spectrum penicillins

VRE - use of vancomycin in renal units

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4
Q

Key things to take into account when deciding whether or not to prescribe an antibiotic?

A

Previous microbiology
Allergies
Appropriate route of administration
Source of infection
Likely pathogens
Antibiotic policy
Need for senior advice

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5
Q

When prescribing an antibiotic, what must you include on the kardex?

A

Indication for use, drug, dose, administration, review date

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6
Q

How soon should you start antibiotics in a patient with life-threatening illness?

A

Within the first hour

Responsibility of the Dr who first sees the patient to administer the first IV dose.

N.B. Cultures taken first!

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7
Q

When shoud IV antibiotic administration be reviewed?

A

After 48hrs.

Switch to oral, narrrow spectrum or OPAT (outpatient, parenteral antibiotic)

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8
Q

Factors that lead to increased risk of resistance

A

Inappropriate use of antibiotics

Poor infection control

Excessive antiiotic use in non-clinical settings

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9
Q

Give three examples of how antibiotics lead to HAIs (describe)

A

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

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10
Q

When are antibiotics used prophylactically?

A

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

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11
Q

What is targeted antibiotic therapy?

A

Wen the infection and causative organism are known

Best way of effective treatment because the sensitivity of the pathogen can be determined

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12
Q

What is empiracal antibiotic therapy?

A

Antibiotic given without knowing the causative organism

Choice basd on practical experience, EBM. Therapy used to cover all possibilities until cause is determined.

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13
Q

Antibiotics which are not excreted in the urine

A

Flucloxacillin

Erythromycin/clarithromycin

Doxycyclin

Clindamycin

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14
Q

Standard infection control precautions

A

Hand Hygiene
Safe use of Sharps
Protective Clothing
Clinical Waste Disposal

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15
Q

Prevention of C. difficile infections in hospital

A

Reduce antibiotic use generally
Reduce specific antibiotics (cephalosporins and ciprofloxacin)
Isolate infectious patients
Treat infected patients to reduce diarrhoea
Clean the environment

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