Antimicrobial stewardship program 2016

1. Antimicrobial
Stewardship
Program
at SCGH
Jason Seet
ID/Critical Care Pharmacist
Sir Charles Gairdner Hospital

2. Background
 All drugs have adverse effects
 Antibiotics have an ‘additional effect’
 Known as ‘collateral damage’
 Refers to the impact of the antibiotic on the
colonising bacterial flora
 Selection of antibiotic resistant
microorganisms
 Patient becomes colonised with resistant
organisms

3. The dilemma...
 Antibiotics are one of the most important
discoveries in modern medicine..
 However, inappropriate use of
antimicrobials may lead to ‘collateral
damage’
 On the other hand..
 Severe restriction of antibiotics (inadequate
therapy) in seriously ill patients is associated
with increased mortality

4. ??.. Solution
The role of the Antibiotic Stewardship Program is to
strike a balance between appropriately treating
the patient and avoiding the selection of
antibiotic resistant organisms

5. Role of antimicrobial
stewardship programs (ASP)
 Aim to
 Optimise antimicrobial therapy (PRIORITY)
 Improve overall patient outcome
 Minimise adverse events
 Decrease the risk of development of
antimicrobial resistance
 Reduce treatment related costs

6. How is this achieved?
To optimise therapy
 Improve selection/choice of antimicrobial – refer
to microorganism, susceptibilities, resistance
patterns, antibiotic spectrum
 Duration (eg: t1/2), overall therapy duration
 Dose – site of infection, drug factors (Vd, Cl,
bioavailability)
 Route of administration (IV vs po)

7. How is this achieved?
 Reduce antimicrobial costs
 Limit overuse
 Narrow spectrum chosen (avoid inappropriate use)
 Promote active IV to po switch
 Reduce hospital length of stay (minimising
infections due to resistant organisms)
 Minimise adverse events
 TDM
 Dosage adjustments (individualise therapy)

8. NAUSP 2006-2009 data
Data demonstrating total antibiotic usage amongst hospitals in
Australia

9. How did SCGH fare in 2009…?
Cefepime
Clindamycin
Ciprofloxacin
Azithromycin
Meropenem
Timentin/Tazocin
Augmentin DF
The podium of shame

10. Outcome of this high usage..
 Implementation of an Antimicrobial
Stewardship Program (February 2010)
 HAPI (Healthy Antimicrobial Prescribing
Initiative)
 ‘ward-side’ review of restricted antimicrobial
therapy
 Written recommendations documented in notes

11. HAPI RoundAntimicrobial
Committee
Site-specific
guidelines and
antibiograms
Electronic
decision
support

12. HAPI rounds
Consists of
ID Pharmacist
ID Physician/Clinical Microbiologist
+/- ID Registrar
+/- Microbiology Registrar
Review of patients on
Restricted antimicrobials
Prolonged course/s of antimicrobials

13. HAPI rounds
The team will provide advice to the treating
team in regards to most appropriate
antimicrobial therapy
Eg
Cessation of therapy
Change in therapy
Narrow therapy
Broaden therapy
Switch to oral de-escalation
Referral for ID consult

14. Why we need AMS?
Broad spectrum antimicrobials
commenced
Appropriate therapy
initially
Micro results return
Pathogen identified
Susceptibility results
available
Patient improves..
But still on broad spectrum
antimicrobials
Infection resolved.
Patient still on broad
spectrum antimicrobials
Patient ready for discharge
Broad spectrum IV antimicrobials
changed to broad spectrum
oral antimicrobials

15. Impact of AMS rounds
SCGH

16. Ongoing reduced usage
SCGH

17. HAPI rounds
 4 x week rounds on general wards
 2 x week rounds in ICU and GHDU
 1 weekly round with Haematology team
Soon..
 eReferral option to AMS (HAPI team) for
assistance with antimicrobial choices, de-
escalation of therapy etc

18. Can we relax…?

19. Can we relax…?

20. How can I find out more info?
http://chips.qe2.health.wa.gov.au/projects/HAPI/index.html

21. Contact your clinical
pharmacist
Link available via DFS
http://dfsprod.hdwa.health.wa.gov.au/LoginPage.aspx

22. What can YOU do?
 Overuse/abuse of antimicrobials affects
everyone!
 How can you help?
 Request the prescribers to document
antimicrobial indication on chart
 Antimicrobials warranted?
 Encourage the prescriber to request ID
approval for restricted antimicrobials
 Question antimicrobial duration/s
 Encourage IV to oral switch
 Refer patients on prolonged antimicrobials to
the HAPI team or your clinical pharmacist