Antimicrobial stewardship Flashcards
(45 cards)
What is antimicrobial resistance?
Resistance of a microorganism to an antimicrobial medicine to which it was originally sensitive.
What are the consequences of antimicrobial resistance?
- Prolonged illness
- Greater risk of spread
- Increased morbidity
- Higher mortality
- Socioeconomic implications
What is antimicrobial stewardship?
- Measures used to select the best therapy for patients for best clinical outcome and minimised toxicity.
- Aims to prevent overuse and inappropriate use of antibiotics to reduce resistance
- Using the correct dose, duration etc
What is the TARGET toolkit?
A guide for GPs and other healthcare professionals to stop antibiotic overprescribing in community care.
Treat
Antibiotics
Responsibly
Guidance
Education
Tools
What is the golden hour?
This is the rule that sepsis patients should be on antibiotics and IV fluid within 1 hour.
What are the outcomes for the 48 hour review of the ‘Start smart and then review’ protocol?
- Stop if not needed- e.g. if not a bacterial infection
- Switch from IV to oral
- Change to a more specific antibiotic- narrow spectrum
- Continue and review after 24 hours
- OPAT- OutPatient Antibiotic Therapy- once a day IV infusion antibiotic given at home.
What methods are used to identify that a patient has an infection?
- Near patient investigations e.g. fever, urinalysis ( dipstick tests not for over 65)
- Microbiology investigations e.g. bacteria account for UTI is greater than 10^5 organisms per ml
What does ‘S’ and ‘R’ mean on a sensitivities culture?
S = sensitive
R= resistant
When should a sample for sensitivities/ microbiology cultures be taken?
Before starting empirical treatment
When should empirical treatment be started?
In severe conditions, empirical treatments should be started without waiting for microbiology results.
What can be used to demonstrate presence of infections?
- White cell count (WCC)- by taking a blood test
Normal range= 4-11 x10^9/L
if this is raised, it can indicate infection
in some cases it won’t raise e.g. accesses, bacterial endocarditis
- C Reactive protein (CRP)- measure the acute phase protein that is made by the liver after infection.
normal range = 0-10
non-specific- could mean infection but also could indicate inflammation - Creatinine levels
Measure kidney function
can be raised in UTIs or sepsis
near-bed observations- fever, temperature, other symptoms
When does targeted treatment begin?
Once microbiology results are available.
What is empiric treatment?
Starting treatment according to signs and symptoms and then using hospital guidelines before receiving any test results.
Where do anaerobes bacteria tend to effect and what kind of conditions do they cause?
Mouth, throat, sinus, Lowe bowel
- Abscesses
- Dental infection
- Peritonitis
- Appendicitis
Where do Gram positive bacteria tend to effect and what kind of conditions do they cause?
Skin, mucous membranes
- Pneumonia
- sinusitis
- Cellulitis
- Osteomyelitis
Where do Gram negative bacteria tend to effect and what kind of conditions do they cause?
Gi tract
- peritonitis
- pancreatitis
- UTI
- PID
Where do atypical bacteria tend to effect and what kind of conditions do they cause?
Chest, genito-urinary
- Pneumonia
- Urethritis
- PID
What are broad spectrum antibiotics and give examples…
Antibiotics that can treat both gram-positive and gram-negative bacteria.
e.g. Co-amoxiclav
meropenem
ceftriaxone
diptazobactam
amoxicllin
doxycycline
Examples of bacteria for gram-positive infections?
Vancomycin
Daptomycin
Flucloxacillimn
Examples of bacteria for gram-negative infections?
Ceftazidime
colistrin
gentamicin
What two factors determine how effective empirical treatment will be?
- Local pathogen epidemiology
- Local antibiotic sensitivity data
What does it mean to ‘Streamline’ in antibiotic treatment?
To go from a broad spectrum antibiotic to a narrow spectrum antibiotic when sensitivities data becomes available.
What organism factors determine antibiotic choice?
- ‘Best guess’ prior to cultures and sensitivities
- Site of infection- ensure the antibiotic will penetrate to the site. e.g. if needed in the brain must be able to cross the blood:brain barrier
- Effect of drug on organism e.g. kill it= bactericidal or stop growth= bacteriostatic
What does a Bactericidal antibiotic do?
Kill the organism
