Antimicrobial Stewardship - Block 1

Question 1

What is AS?

Answer 1

Optimal selection, doage, and duration of ABX tx for best clinical outcome to minimie toxicity and resistance

Question 2

What are the goals of AS?

Answer 2

1. Patient recieves appropriate ABX
2. Prevent overuse, misuse, and abuse
3. Minimize the development of resistance

Question 3

What are the steps for optimal ABX therapy?

Answer 3

Right:
1. Drug
2. Dose
3. De-escalation
4. Duration

Question 4

What is de-escalation?

Answer 4

1. Broad -> narrow
2. Combo -> mono
3. Stopping ABX when its no longer needed

Question 5

What is overuse?

Answer 5

Providers use ABX when not necessary

Question 6

What is misuse?

Answer 6

Failure to ajust ABX based on culture results

Question 7

What is abuse?

Answer 7

Use of particular ABX preferentially over others (excess dose)

Question 8

What are the CDC core elements?

Answer 8

Leadership commitment
Accountability
Drug expertise
Reporting
Action
Tracking
Education

Question 9

What are AS strategies?

Answer 9

1. Formulaties and PA
2. Prospective review and feedback
3. Rapid diagnostic tests
4. Order sets and algorithms
5. Education
6. Computer descision programs
7. IV -> PO switch
8. Dosing programs
9. Antibiogram

Question 10

What is an antibiogram?

Answer 10

Periodic summary of antimicrobial susceptibilities of local bacterial isolates from the lab

Question 11

Who qualifies for IV->PO conversion?

Answer 11

Clinically stable, normal diet, taking other PO meds

Question 12

Benefits from IV-> PO?

Answer 12

1. Comfort and mobility
2. Reduced exposure to nosocomi pathogens
3. Decreased phlebitis risk
4. Reduced prep and admin time
5. Lower cst
6. Decreased length of stay

Question 13

What is the significance of renal dosing?

Answer 13

Many antimicrobials need renal adj (vanc, AG)

Question 14

What is MDRO?

Answer 14

Microorganisms (mainly bacteria) that are resistant to one or more clasees of ABX

Question 15

How does resistance develop?

Answer 15

1. Overuse of ABX can lead to the development of resistant strains of bacteria
   * ABX use increases risk of developing ABX resistance
2. ABX resistance is a serious patient safety and public health threat

Question 16

What are the common mechanisms of resistance?

Answer 16

1. Decreased cellular permeaility
2. Efflux pumps
3. Altered drug targets
4. Inactivating enzymes (b-lactams)
5. Genetic mutations, new genes, transfer of genes

Question 17

What are the risk factors of ABX resistance?

Answer 17

1. Higher mortality
2. Worse outcomes
3. Higher healthcare costs

Question 18

Identify the risk facotrs for MRSA?

Answer 18

1. Antibiotic use
2. HIV infection
3. Injection drug use
4. Presence of an indwelling HD catheter
5. Residence in a LTC facility

Question 19

MSSA tx?

Answer 19

1. Nafcillin
2. Oxacillin
3. Dicloxacillin
4. Cefazolin
5. Cephalexin

Question 20

MRSA Tx?

Answer 20

1. Vanc
2. Linezolid
3. Daptomycin

Question 21

RF of VRE

Answer 21

1. Past antimicrobial therapy
2. Patient characteristics:
   * Hospitalization >72H
   * Significant underlying med conditions
   * PPI
   * ICU care
   * Invasive devices

Question 22

Tx for enterococcus?

Answer 22

1. Penicillin G
2. Ampicillin
3. Amoxicillin PO
4. Ampicillin sulbactam (if beta-lactamase is present)
5. Vanc (pen resistant)

Question 23

Tx for VRE?

Answer 23

Daptomycin
Linezolid

Question 24

RF of ESBL?

Answer 24

1. Colonization of GIT
2. CA infection (abx use, use of CS, percutaneous feeding tube)
3. Traveling abroad

Question 25

Enterobacteriaceae tx?

Answer 25

Kleb.
1. Ceftriazone
2. Zosyn
3. Ciprofloxacin
4. Levofloxacin

Question 26

Tx for ESBL producing Kleb or E coli?

Answer 26

1. Meropenem
2. Ertapenem
3. Imipenem