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Antimicrobial Stewardship PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Antimicrobial stewardship" by MERIN VARGHESE, MD.

This medical PowerPoint presentation is about antimicrobial stewardship, a set of coordinated strategies and actions aimed at promoting the appropriate use of antimicrobial agents (such as antibiotics, antifungals, and antivirals) in order to minimize the development of antibiotic resistance, reduce healthcare costs, and improve patient outcomes.

The goal of antimicrobial stewardship is to ensure that antimicrobial drugs are used only when they are needed, in the correct dosage and duration, and in a way that minimizes the risk of adverse effects. This involves a multidisciplinary approach, with input from healthcare providers, pharmacists, laboratory personnel, and infection control professionals.

Tags : antimicrobial stewardship, appropriate use of antimicrobial agents, antibiotics, antifungals, antivirals, antibiotic resistance, pharmaceuticals, pharmaceuticals PowerPoint presentations

Published on : Jun 23, 2023 | Views : 998 | Downloads : 0

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Slide 1-

ANTIMICROBIAL STEWARDSHIP MERIN VARGHESE, MD PHYSICIAN, NGPG INFECTIOUS DISESASE CHAIR AND PHYSICIAN LEAD, NGHS ANTIMICROBIAL STEWARDSHIP COMMITTEE
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NO FINANCIANCIAL DISCLOSURES
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Objectives Define antimicrobial stewardship program Purpose of antimicrobial stewardship program Understanding B-lactam allergies with respect to antimicrobial stewardship
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THE BUGS ARE WINNING…
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Antimicrobial Resistance is a Growing Problem More than 2.8 million antibiotic-resistant infections occur in the U.S. each year. More than 35,000 people die as a result, according to CDC’s 2019 Antibiotic Resistance Threats Report. The estimated national cost to treat infections caused by six multidrug-resistant germs frequently found in health care can be substantial—more than $4.6 billion annually https://www.cdc.gov/drugresistance/national-estimates.html
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ANTIMICROBIAL RESISTANCE
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SHARING THE RESTISTANCE
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SHARING THE RESISTANCE
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HOW ANTIMICROBIAL RESISTANCE SPREADS https://www.cdc.gov/narms/faq.html
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ANTIMICROBIAL RESISTANCE THREATS
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BUGS FIGHTING BACK
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ANTIMICROBIAL STEWARDSHIP Per Infectious Disease Society of America (IDSA) – Antimicrobial stewardship is an activity that promotes Appropriate selection of antimicrobials Appropriate dosing of antimicrobials Appropriate route and duration of antimicrobial therapy
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GOALS OF ANTIMICROBIAL STEWARDSHIP What is antimicrobial stewardship? Antibiotic stewardship refers to a set of commitments and activities designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The goal is… to have the RIGHT DRUG for the RIGHT PERSON over the RIGHT TIME FRAME AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI
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GOALS OF ANTIMICROBIAL STEWARDSHIP Primary goal Optimize clinical outcomes while minimizing unintended consequences of antimicrobial use Unintended consequence Toxicity Selection of pathogenic organisms such as C. difficile Emergence of resistant pathogens Secondary goal Reduce healthcare costs without adversely impacting the quality of care
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PREVENT ANTIMICROBIAL RESISTANCE AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Infection prevention IS antimicrobial stewardship! Tracking infection prevention data has double value Hospital acquired infection prevention Informs antibiotic stewardship programs Improving antibiotic prescribing Bacteria are constantly evolving, requiring the need for new antibiotics Source: Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.
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WE MUST WORK TOGETHER… Working relationship between infection control and antimicrobial management. Selection of antimicrobials from each class of drugs that does the LEAST collateral damage Collateral damage Methicillin-resistant Staphylococcus aureus Extended spectrum B-lactamase (ESBL) Clostridioides difficile (C. difficile) Vancomycin-resistant enterococci (VRE) Metalloenzymes & other carbapenemases Appropriate de-escalation when culture results are available
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DRUGS CAN’T KEEP UP
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NGHS ASP Structure Reports to: Pharmacy & Therapeutics Committee Infection Control Committee NGMC Quality Committee Acute Care Campuses Gainesville Braselton Barrow Lumpkin Skilled Nursing Limestone Lanier Park Outpatient NGPG Urgent Care NGPG Clinics
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TODAY’S FOCUS What is antimicrobial stewardship? Antibiotic stewardship refers to a set of commitments and activities designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The goal is… to have the RIGHT DRUG for the RIGHT PERSON over the RIGHT TIME FRAME
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TODAY’S FOCUS Penicillin allergy
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PENICILLIN ALLERGY Up to 10% of the general population and 15% of hospitalized patients list penicillin as an allergy.
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PENICILLIN ALLERGY https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf
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PENICILLIN ALLERGY Penicillin “allergic” patients are more likely to Received fluroquinolones, vancomycin, clindamycin Harbor drug resistant organisms such as MRSA and VRE Develop C diff colitis Increased mortality Experience -- treatment failure, infection recurrence, death from MSSA bacteremia treatment failure in gram negative bacteremia a delay in empiric antimicrobial treatment a surgical site infection
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PENICILLIN ALLERGY Pencillin “allergic” patients are more likely to Develop new antibiotic “allergies” with alternative therapies Have an allergic reaction to vancomycin than cefazolin Have side effects or toxicities from second-line therapies
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PENCILLIN ALLERGY Penicillin allergic patients have higher drug costs Higher outpatient antibiotic costs per patient $300 more per patient per day of inpatient antibiotic therapy $1253 more in length of stay costs per patient per admission Penicillin allergic patients have longer hospital stays 10% longer hospital stays, estimated cost of $21.5 million per year.
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PENICILLIN ALLERGY: ACCURATE DIAGNOSIS? Less than 10% of these allergies are confirmed when tested Childhood viral rashes are often misdiagnosed as drug rashes Only 7-16% of kids with “drug allergy” during an infection later test positive to the drug. Even if a patient is truly allergic, most people “outgrow” penicillin allergy Over 50% of people with confirmed allergy to penicillin ‘lose their allergy’ after 5 years Over 80% will lose it in 10 years
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BETA LACTAMS
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CEPHALOPSORIN VS PENICILLIN Overall cross-reactivity based on multiple studies is actually very low: Reported (but unconfirmed) penicillin allergy: 0.1% Confirmed penicillin allergy: 2% Above exclude patients with penicillin anaphylaxis
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PENICILLIN ALLERGY
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OUR EFFORTS Cascading susceptibilities Drug desensitization Drug challenge
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Cascading Susceptibilities Definition a strategy of reporting antimicrobial susceptibility test results in which secondary (e.g., broader-spectrum, more costly) agents may only be reported if an organism is resistant to primary agents within a particular drug class
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Old New
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Graded Challenge/Test Doses 1%/10%/20% Monitoring Vital signs every 30 minutes Rescue meds available (diphenhydramine, epinephrine, methylprednisolone) Update allergy profile after challenge
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Graded Challenge (GC)
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Desensitization Monitoring Requires 1:1 nursing ratio ICU admission likely required Airway box at bedside Vital signs every 30 minutes Rescue meds available (diphenhydramine, epinephrine, methylprednisolone) Desensitization establishes a temporary tolerance so allergy on profile is relevant and should remain there 18 step process
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Desensitization
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Graded Challenge vs Desensitization Solensky. Immunol Allergy Clin N Am 24 (2004) 425–443 Solensky. Ann Allergy Asthma Immunol 2010;105:259
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Is The Risk Worth It? Risk of life-threatening reaction to beta lactams in those with reported allergies – very low if they are screened for mild reactions and antimicrobials are chosen carefully. With the use of LIFE THREATENING infection - MUCH HIGHER when ALTERNATIVE agents are used. C. difficile colitis kills about 29,000 per year Fatal drug induced anaphylaxis (1999-2010) – antibiotics were identified as culprits in 585 deaths (12 year period). https://www.sciencedirect.com/science/article/pii/S0091674914011907?via%3Dihub
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THANK YOU
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REFERENCES Cdc.gov https://www.sciencedirect.com/science/article/pii/S0091674914011907?via%3Dihub Solensky. Immunol Allergy Clin N Am 24 (2004) 425–443. Solensky. Ann Allergy Asthma Immunol 2010;105:259 https://www.publichealthontario.ca/apps/asp-strategies/data/pdf/ASP_Strategy_Cascading_Microbiology_Reporting.pdf https://www.researchgate.net/figure/The-Partners-Penicillin-and-Cephalosporin-Hypersensitivity-Pathway-These-pathway_fig2_316781890 https://www.ryah.ca/2014/09/29/animal-health-week-antibiotic-responsible-and-appropriate-use/ https://www.istockphoto.com/illustrations/antibiotic-resistance http://love-life-science.blogspot.com/2014/09/bacterial-gifts.html?spref=pi