An 82-year-old woman presented with dry cough, shortness of breath, and inability to lie flat. Laboratory tests showed elevated white blood cell count and BNP level. The document discusses antibiotic stewardship, which aims to optimize clinical outcomes while minimizing unintended consequences of antibiotic use, such as emergence of resistance. It provides strategies for judicious antibiotic selection and use, including monitoring local resistance patterns, limiting duration of therapy, and tracking antibiotic use.
3. An 82 woman
c/o dry cough SOB and
can't lie down flat.
o/e: RR = 22 /min;
spO2=94%; others are
normal and no LL
edema
Labs : WBCs= Noramal ;
BNP= 680 pg/mL
16. Strategy ?
• assess local susceptibility rates
• selecting a good empirical antibiotic therapy
• monitoring resistance trends over time
17. What is antibiogram?
Antibiogram is a periodic summary of
antimicrobial susceptibilities of local bacterial
isolates submitted to the hospital's clinical
microbiology laboratory.
22. What is Antimicrobial
Stewardship?
Using the right antibiotic
at the right time
at the right dose
for the right duration
The White House. National Action Plan for Combating Antibiotic-Resistant Bacteria.
IDSA and the SHEA guidelines for developing an institutional program to enhance antimicrobial stewardship.
23. Primary goal
Optimize clinical outcomes while minimizing
unintended consequences of antimicrobial use, including
toxicity, the selection of pathogenic organisms, and the
emergence of resistance
The White House. National Action Plan for Combating Antibiotic-Resistant Bacteria.
IDSA and the SHEA guidelines for developing an institutional program to enhance antimicrobial stewardship.
24. Goals of Antibiotic Stewardship
streamline therapy and improve outcomes
set duration of therapy
Improves handoff communication
Reduces the emergence of multi-drug
resistant pathogens
Reduces adverse drug reactions
25. Core Elements for outpatient
Antimicrobial Stewardship Programs
In patient and Nursing Home
1.Commitment
2.Accountability
3.Drug Expertise
4.Action
5.Tracking
6.Reporting
7.Education
Out patients and ER
• Commitment
• Action for policy and
practice
• tracking and reporting
• Education and
expertise.
http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
26. Principles
1. Obtain Quality Cultures
1. Before antibiotics initiated (if possible)
2. Utilize Respiratory Therapy to obtain sputum samples
3. Avoid surface cultures
2. Establish source control if applicable
3. Indications are written with all antibiotic orders
4. Stream line to narrow spectrum antibiotics following culture results
5. Set antibiotic durations of therapy at time of prescribing or immediately
following clinical response
27. Quality Measures
• Multidisciplinary process to review antimicrobial
utilization and local susceptibility patterns
• Systems to prompt appropriate use of antimicrobial
agents
• Antibiotic orders include indication for use
• Clinician review of need/selection of antibiotics at
72 hours
• IV to PO program
28.
29.
30.
31. AAEM Recommendations
1. Withhold antibiotics for uncomplicated RTI.
2. The modified Centor score.
3. Avoid antibiotics for uncomplicated abscesses.
4. Administer broad-spectrum antibiotics to
patients with septic shock early.
5. Consider cultures when initiating antibiotic.
6. Determine local antimicrobial susceptibilities
7. An Antibiotic Stewardship Champion.
8. A multidisciplinary, antibiotic usage, quality
improvement process
9. Antibiotic order sets and clinical decision
support systems.
10. Post-prescription culture review
32.
33. Procalcitonin as a biomarker of
infectious diseases
Antibiotics can generally be
withheld in cases of suspected
respiratory infection or sepsis when
the likelihood of infection is low
and the PCT result is < 0.25 ng/mL.
1. Harbarth S et al. Am J Respir Crit Care Med 2001,164: 396-402
2. Kumar Meisner et al., Crit Care 1999,3:45-50
• Schuetz P, Chappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions. Arch Intern Med. 2011;171:1322-1331. Abstract
• Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9:107.
• Riedel S, Melendez JH, An AT. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Path 2011;135:182-189.
34. Antimicrobial Stewardship in
Saudi Arabia
• Antibiotics awareness week only last November
• After it MOH guided to establish the program in all
her hospitals and advised to be added to the
CEBAHI
• STILL the Harmonizing body is under development
• There was individual activities
38. Take home message
• Antimicrobial resistance is responsibility
of us all
• Stay up-to-date in local resistance or at
least recent national clinical guideline
• Think many time before prescribing Abx
and involve your patient abouth risks
• Help from the clinical pharmacist is not
shameful
39.
40. • National Action Plan for Combating
Antibiotic-Resistant Bacteria (Goals)
MARCH
2015
• Slow emergence of resistant bacteria and prevent spread
• Strengthen National One-Health surveillance efforts to combat resistance
• Advance development and use of rapid and innovative diagnostic tests for
identification and characterization of resistant bacteria
• Accelerate basic and applied research and development of new
antibiotics, other therapeutics, and vaccines
• Improve international collaboration and capacities for antibiotic-resistance
prevention, surveillance, control, and antibiotic research and development
The White House. National Action Plan for Combating Antibiotic-Resistant Bacteria.
Editor's Notes
antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few.
Overuse of beta-lactam antibiotics in the 1980’s lead to Staphylococcus aureus developing resistance by altering the PBP in the cell wall
Led to the development of Methicillin-Resistant Staphylococcus aureus (MRSA) In most hospitals MRSA is now the predominant strain of Staphylococcus aureus
National Ambulatory Medical Care Survey (NAMCS) and The National Hospital Ambulatory Medical Care Survey (NHAMCS)
Assessment of domestic antibiotic resistance threats
18 November
Conclusion and Recommendation
In conclusion, misuse of antibiotic is a serious concern
in public health problem worldwide. Most Saudi
literature emphasized on prevalence studies and revealed
a considerable high prevalence of antibiotic misuse
among Saudi population, particularly among children.
On the other hand, there is a great lack of study regarding
other epidemiologic aspects of antibiotic misuse. The
future researchers have to address this aspect as well as
increasing awareness of the public, about the impacts of
misuse of antibiotics.
Finally, it is recommended to study the global intervention
strategies and policies in common use and to find out the
suitable protocol to be used in our country, Saudi Arabia.
According to the influencing factors to this problem
Other Use
compare susceptibility rates across institutions and track resistance trends
The Global Antimicrobial Resistance Surveillance System (GLASS) is a platform for global data sharing on antimicrobial resistance worldwide. It has been launched by WHO as part of the implementation of the Global Action Plan on Antimicrobial Resistance (AMR). The data generated will help to inform national, regional and global decision-making, strategies and advocacy.
1-
sinlge leader
job evaluation
same message to incisting pt
2-
evidence-based diagnostic criteria and treatment recommendations
delayed prescribing practices or watchful waiting, when appropriate
communications skills training for clinicians
written justification in the medical record for nonrecommended antibiotic prescribing
Use call centers, nurse hotlines
3- audit and feedback, Self-evaluate antibiotic prescribing practices, need a system
4-
educate patients no need + harm and give materials
5 year roadmap to guide the Nation in rising to the challenge
Outlines steps for implementing the National Strategy and addresses PCAST recommendations
Organized around 5 goals with objectives (Year 1, 3, 5)
Primary goal: guide activities by the federal government as well as actions by public health, healthcare, and veterinary partners to address this urgent drug-resistant threat