The document discusses antibiotic stewardship and strategies to combat antibiotic resistance. It outlines how inappropriate antibiotic use has led to increased antibiotic resistant organisms and how antimicrobial stewardship aims to optimize antibiotic use and minimize unintended consequences. The document provides numerous examples of antibiotic stewardship strategies including obtaining cultures before prescribing antibiotics, using local antibiotic resistance data to guide treatment, reviewing culture results to modify prescriptions, restricting broad-spectrum antibiotics, and monitoring treatment response and duration. It stresses the importance of education, guidelines, surveillance, and metrics to evaluate antibiotic stewardship programs.

1. ANTIBIOTIC STEWARDSHIP
CURRENT UPDATES
Dr.T.V.Rao MD
2/11/2019
Dr.T.V.Rao MD @ Antibiotic stewardship
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2. Antibiotic Use and the
Burden of Antibiotic
Resistance
•The emergence
of antibiotic
resistant
organisms
(AROs) has been
linked to the
inappropriate
use and overuse
of antibiotics.
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3. ANTIBIOTIC RESISTANCE IS THREAT TO CIVILIZED
SOCIETY
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4. Antimicrobial
Stewardship
• Antimicrobial
stewardship is
recognized as a
critical patient safety
and quality
imperative to combat
the emergence of
antimicrobial
resistance (AMR) and
preserve the activity
of existing agents.
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5. Stewardship formulated to
stop Misuse of antibiotics
• The primary goal of
antimicrobial
stewardship is to
optimize clinical
outcomes while
minimizing
unintended
consequences of
antimicrobial use,
including toxicity and
the emergence of
resistance
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6. CDC Initiates Antibiotic Stewardship
•The most important
national antimicrobial
stewardship initiative
for acute care settings
is the Centers for
Disease Control and
Prevention’s (CDC)
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7. Choosing the Right Diagnostic tests and
antibiotics a priority
•Inherent to its principles are the ongoing evaluation
of the need for antibiotics, the appropriate selection
of a regimen, and optimization of the dose, route
(e.g., intravenous vs. oral) and duration of therapy.
These principles can be applied to empiric use (when
infection is suspected but cultures are pending),
definitive use (when an organism has been
identified), or for prophylaxis (e.g., prevention of
postoperative infections
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8. Get Smart For Health Care
Campaign with example
• Problem -Accurately identify
patients who need antibiotic
therapy
• Solution
• Obtain two blood cultures
for evaluation of late onset
sepsis prior to starting
antibiotics
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9. Choosing Emphatical Antibiotics
therapy with your local
antibiograms
• Utilize local and
regional
antibiograms
• Avoid use of
meropenem for
empiric treatment
of suspected late
onset sepsis if rates
of multi-drug
resistant gram-
negative bacilli are
low.
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10. Chose the
Antibiotics with
Caution
• Avoid therapy with
overlapping activity
• Avoid simultaneous use
of metronidazole and
meropenem to treat
necrotizing
enterocolitis.
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11. Choosing the Right Antibiotic and
optimal dose need of the hour
•Give the right dose and
interval of drug
•Target vancomycin
trough to 15–20 mg/L to
treat pneumonia caused
by MRSA.
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12. Review Culture reports and
Modify antibiotic treatments
•Review culture results and
adjust antibiotics
•Review microbiology results at
transitions of care (e.g. sign out,
weekend cross-coverage) and
narrow antibiotic coverage
promptly.
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14. Monitor Antibiotic
Treatment and toxic
consequences
•Monitor for toxicity
and adjust therapy
accordingly
•Adjust antibiotic dose
for patients with
deteriorating renal
function.
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15. De-escalation of Antibiotic
Treatments a concern and
Important
• Stop therapy promptly
if indicated by culture
results
• Discontinue antibiotics
after 48 hours if blood
cultures are negative
and ongoing infection is
not suspected.
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16. Examples of antimicrobial
stewardship strategies
• Prescriber audit and feedback
• Review of microbiology
results and patient record by
antimicrobial stewardship
team within 48 – 72 hours of
initial approval of
vancomycin with
recommendation to
continue, change or
discontinue antibiotics
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17. Restrict the Use of higher
generation antibiotics
•Formulary restriction and
prior authorization
•Require prior authorization
from the antimicrobial
stewardship team prior to
the use of meropenem
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18. Education on Antibiotic
Stewardship a Priority
• Education and Training a
Priority in reduction of
Antibiotic Missue
• Provide lecture series about
stewardship principles and
antibiotic options for the
treatment of gram-negative
pathogens.
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19. Antibiotic misuse in Clinical
Care to be controlled
• Guidelines and clinical
pathways
• Develop consensus
guidelines for the
duration of treatment
of presumed ‘culture-
negative’ sepsis
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20. Giving the Appropriate
Instructions a Priority
• Antimicrobial
order forms
• Use automatic
stop orders to
provide the correct
duration of
perioperative
prophylaxis
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21. Optimization of
Drug Dosages
• Dose Optimization
• Target vancomycin
trough levels
between 15–20
mg/L for
treatment of
persistent MRSA
bacteremia.
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22. Computer
surveillance
•Computer
surveillance and
decision support
•Automated alerts for
redundant antibiotic
combinations
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23. Monitoring Success of
Antimicrobial Stewardship
• Antimicrobial stewardship
programs should develop
metrics to measure
successful
implementation and
safety rather than
exclusively focusing on
cost saving.
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24. Exalting the Antimicrobials
a continuous Process
• Initial efforts could include
monitoring antimicrobials
that are used most frequently
or incur the most pharmacy
costs. Alternatively agents
with the greatest risk of
toxicity or the greatest risk of
inducing antibiotic resistance
could be monitored
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25. Patient safety and quality metrics for evaluating
antimicrobial stewardship interventions.
• Potential Safety and Quality Metric
• Episodes of ineffective empiric antibiotic therapy (organism/antibiotic
mismatch)
• Mean time to target vancomycin trough concentration for infants with
known MRSA infection
• Proportion of infants receiving appropriate dosing and timing of
perioperative prophylaxis
• Rates of infections with multi-drug resistant gram negative infections
• Episodes of antibiotic-associated adverse events
• Duration of treatment for culture negative presumed late onset sepsis
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26. Emerging Developments in
Antibiotic Stewardship
• Strategies for improving antibiotic
use and evidence for best practices
in antibiotic stewardship are
evolving. The integration of IT into
the clinical data presentation and
decision-making for antibiotic use
will expand with increased uptake
and capabilities of electronic health
records. The role of diagnostic
laboratory testing is another area of
evolution.
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27. Use of Emerging and New
Technologies to reduce
Anti Microbial Resistance
• Rapid diagnostic tests such as
procalcitonin, fluorescence in situ
hybridization using peptide nucleic
acid probes (PNA FISH), and matrix-
assisted laser desorption/ionization
time of flight (MALDI-TOF) mass
spectrometric analysis have been
successfully incorporated by some
stewardship programs and may
become important additions to
stewardship efforts.
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28. Auditing of the matters we
work need constant appraisal
• Another area of on-
going work is better
characterization of the
impact of antibiotic
stewardship
interventions on
resistance.
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30. Finding Better Scientific
Solutions is True Objective of
Antimicrobial stewardship
• As more facilities engage in efforts
to optimize antibiotic use, future
work is needed to evaluate which
interventions or antibiotic targets
yield the greatest benefit in
combating antibiotic resistance.2/11/2019 Dr.T.V.Rao MD @ Antibiotic stewardship 30

31. References
• Core Elements of Hospital Antibiotic Stewardship Programs – Google
knowledge bases
• WHO GUIDLEINES ON ANTIBIOTIC STEWARDSHIP
• CDC growing challenges in Antibiotic Restrained Real time concerns
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32. •Program Created by Dr.T.V.Rao MD for the
benefit of Medical, Nursing and paramedical
professionals for Global reach to make
Scientific approaches in Antibiotic use as a part
of Antibiotic Stewardship
•Email
doctortvrao@gmail.com
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