Antimicrobial Stewardship

University:
Franklin University
Course:
EXS-351 | Kinesiology/Biomechanics
Academic year:

2020
Views:

394

Pages:

34
Author:

AuroraArcher

ANTIMICROBIAL STEWARDSHIP Antimicrobial stewardship What is AMS Why do we need AMSP Goal of AMSP Implementation of AMSP Antimicrobial stewardship Antimicrobial stewardship is the key component of multifaceted approach for preventing emergence antimicrobial resistance : That involves timely and optimal selection, dose and duration of antimicrobial agent Aims to obtaining best clinical outcome of treatment/ prevention of infection With minimal toxicity to patient Minimal impact on resistance and other ecological adverse events WHY do we need AMSP Antimicrobial resistance Misuse and overuse of antibiotics Widespread use of antibiotics in other sectors Antimicrobial prescribing facts Antimicrobial resistance How Antibiotic Resistance Happen? http://www.cdc.gov/drugresistance/threat-report-2013/ Antibiotic Use Drives Resistance Penicillin 1942 vanA genetic transfer 2002 Methicillin 1961 Examples of How Antibiotic Resistance Spreads http://www.cdc.gov/drugresistance/threat-report-2013/ Misuse and overuse of antibiotics Wide spread use of antibiotics Human nontherapeutic 6% Human therapeutic 9% Animal therapeutic 15% Animal nontherapeutic 70% Use of antibiotics in various sectors www.pewhealth.org Antimicrobial Prescribing Facts: The 30% Rule  ~ 30% of all hospitalized inpatients at any given time receive antibiotics  Over 30% of antibiotics are prescribed inappropriately in the community  Up to 30% of all surgical prophylaxis is inappropriate  ~ 30% of hospital pharmacy costs are due to antimicrobial use  10-30% of pharmacy costs can be saved by antimicrobial stewardship programs [Hoffman et al., 2007; Wise et al., 1999; John et al., 1997] GOALS of AMSP Primary Secondary GOALS of AMSP Combat antimicrobial resistance Improve patient safety Improve patient outcome AMSP Reduce health care cost Implementation of AMSP SUPPORT FROM ADMINISTRATIV E SUPPORT (Leadership) SET UP OF AMS Team 1. Microbiology lab. 2. Pharmacology lab 3. Information technology 4. Infection control committee FRAMING ANTIMICROBIAL POLICY Implementation of AMSP….. EDUCATION AND TRAINING IMPLEMENTING AMS STATERGIES FRAMING ANTIMICROBIAL POLICY 1. Restriction category 2. Antibiotic cycling Steps in implementation of AMSP ADMINISTRATIVE SUPPORT (Leadership) Necessary funding Infrastructure support Support training and education Ensure participation SET-UP of AMS Team SUPPORT from Microbiology lab.  Microbiologically guided patient diagnosis  Rapid diagnosis  AST & anti-biogram generation  Selective or cascade reporting  Test to rule out bacterial infection SUPPORT from Pharmacology lab.  Therapeutic drug monitoring  Ensuring sufficient antimicrobial concentration  Minimize risk of toxicity SUPPORT from Information Technology  Data entry  Instant sending of reports  No risk of loss of data  Statistics  Bidirectional communication  Online access of reports SUPPORT from Infection control committee Antimicrobial stewardship Laboratory stewardship Infection control stewardship FRAMING ANTIMICROBIAL POLICY  Compliance to standard national and international antibiotic guidelines  Involvement of complete AMS team  System or syndrome wise indications IMPLEMENTING AMS STATERGIES Front end Formulary restriction with preauthorization Antibiotic cycling Back end Prospective audit and feedback IMPLEMENTING AMS STATERGIES Formulary Restriction & reauthorization  Obtaining approval  Preauthorization form IMPLEMENTING AMS STATERGIES Restriction category & preauthorization Restricted antimicrobials Semi- restricted antimicrobials Unrestricted antimicrobials • Pharmacy supply of >1day requires prior approval by AMS team • Colistin • Carbapenem • tigecycline • Pharmacy supply of >3day requires prior approval by AMS team • Teicoplanin, vancomycin • Linezolid • 3rd and 4th generation cephalosporins • Pharmacy supply of does not requires prior approval by AMS team • 1st and 2nd generation cephalosporins • Cotrimoxazole • Azithromycin • Clarithromycin IMPLEMENTING AMS STATERGIES Antibiotic cycling substitution withdrawal IMPLEMENTING AMS STATERGIES others …..  Dose optimization  Low hanging fruits  Duration optimization  Avoid redundant antibiotic  Intravenous to oral conversion  Streamlining/ deescalation combinations  Start Smart – then focus strategy  MIND ME Practice Guideline Recommendations regarding duration of therapy Adapted from Wlodover et al., Infect. Dis. Clin. Pract. 2012;20:12-17. C O M M U N I C A T E Conversion from intravenous to oral antimicrobials The Golden Rules of Antimicrobial Prescribing “MINDME”. M I N D Microbiology guides therapy wherever possible Indications should be evidence based Narrowest spectrum required Dosage appropriate to the site and type of infection M Minimise duration of therapy E Ensure monotherapy in most cases Adapted from Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 14. Melbourne: Therapeutic Guidelines Limited; 2010. EDUCATION AND TRAINING  Education strategies  Stake holders  Frequency  Periodic assessment AMSP in INDIA National networks Responsibility Main objective National program for containment of antimicrobial resistance National center for disease control (NCDC) AMR surveillance Antimicrobial resistance surveillance research network Indian council of AMR surveillance medical research (ICMR) Research Capacity building and strengthening of hospital infection control to detect and prevent antimicrobial resistance in India Indian council of medical research (ICMR)and CDC, India Initiating antimicrobial stewardship activities in hospitals in India Indian council of Antimicrobial medical research (ICMR) Stewardship Hospital acquired infection (HAI)surveillance