Dr.sherin elsherbiny
Senior registrar clinical microbiology
AMR coordinator
Infection control auditor
Riyadh region
Meeqat General Hospital ,Madina,KSA
Dr.sherin elsherbiny
Senior registrar clinical microbiology
AMR coordinator
Infection control auditor
Riyadh region
Meeqat General Hospital ,Madina,KSA
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
For decades microbes, in particular bacteria, have become increasingly resistant to various antimicrobials.
The World Health Assembly’s endorsement of the Global Action Plan on Antimicrobial Resistance (AMR) in May 2015, and the Political Declaration of the High-Level Meeting of the General Assembly on AMR in September 2017, both recognize AMR as a global threat to public health.
These policy initiatives acknowledge overuse and misuse of antimicrobials as a main driver for development of resistance, as well as a need to optimize the use of antimicrobials.
The Global Action Plan on AMR sets out five strategic objectives as a blueprint for countries in developing national action plans (NAPs) on AMR:
Objective 1: Improve awareness and understanding of AMR through effective communication, education and training.
Objective 2: Strengthen the knowledge and evidence base through surveillance and research.
Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.
Objective 4: Optimize the use of antimicrobial medicines in human and animal health.
Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Antimicrobial stewardship programmes optimize the use of antimicrobials, improve patient outcomes, reduce AMR and health-care-associated infections, and save health-care costs amongst others.
Today, AMS is one of three “pillars” of an integrated approach to health systems strengthening. The other two are infection prevention and control (IPC) and medicine and patient safety.
Linking all three pillars to other key components of infection management and health systems strengthening, such as AMR surveillance and adequate supply of quality assured medicines, promotes equitable and quality health care towards the goal of achieving universal health coverage
CDC has defined “Antimicrobial stewardship” as-
The right antibiotic
for the right patient,
at the right time,
with the right dose, and
the right route, causing
the least harm to the patient and future patients
Why AMSP is needed?
Antimicrobial Resistance (AMR)
Misuse and Over-use of Antimicrobials
Widespread Use of Antimicrobials in Other Sectors
Poor Antimicrobial Research
IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAM
Administrative Support (Leadership)
Formulating AMS Team
Infrastructure Support
Framing Antimicrobial Policy
Implementing AMS strategies
Education and Training
Should be publicly committed to the program.
Provide necessary funding and infrastructure support.
Multidisciplinary committee - responsible for framing, implementing and monitoring the compliance to antimicrobial policy of the hospital.
Led by the antimicrobial steward - infectious disease physician or infection control officer or clinical microbiologist.
Other members of AMS team - stewardship nurses
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Antimicrobial stewardship programs (ASP) are an essential practice to prevent increasing
resistance against antibiotics. A successful ASP monitors not only prescribing patterns and
practices but also contributes in minimizing the toxic effects of antibiotics. Moreover, ASP
also facilitates the selection of disease specific antibiotics and enforces rules and regulations to rationalize the use of antibiotics. The aim of the study is to highlight the core
elements of Hospital Antibiotic Stewardship Programs in Karachi. The key elements proposed by center of disease control (CDC) such as; leadership, accountability, drug
expertise, actions to support optimal antibiotic use, tracking (monitoring antibiotic prescribing, use and resistance), reporting information to staff on improving antibiotic use
and resistance and education were evaluated on Yes/No scale. The data was collected
from 44 hospitals of different categories in Karachi and all the major elements were
studied. It was observed that all the hospitals in one setting failed to comply with all the
guidelines. It has been concluded that efforts should be made to design ASP at each
hospital and implemented through suitable policies and procedures.
This power point briefly describe definition, importance, core elements, principle hospital implementations and gaps of antimicrobial stewardship. In addition some recommendations are also mentioned.
This was powerpoint was requested by an attending physician to be shared with the Psychiatric providers regarding DVT prophylaxis in patients who may have been on the unit. They include recommendations as outlined by the ACCP 2012 Guidelines for prevention of venous thromboembolism
Basic Pharmacy Calculations and PharmacokinetesJoy Awoniyi
This was a lecture presented to the Davie campus of Florida A&M University College of Pharmacy P4 students. The lecture was presented during their final semester, at a course geared towards NAPLEX preparation. During the lecture, students wer asked to participate. We worked through each problem together and questions were encouraged.
This case was presented during an Ambulatory Care rotation at 7th Avenue Clinic with Dr. Norwood in July 2011. I was assignment was to write a detailed SOAP Note regarding the case, summarizing pertinent problems and pharmacy-related recommendations
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
IDSA Practice Guidelines for Antimicrobial Stewardship Programs
1. IDSA Practice Guidelines for
Antimicrobial Stewardship
Programs
Dr. Joy A. Awoniyi, PharmD.
PGY1 Clinical Pharmacy Practice Resident
Miami VA Healthcare System
17th Annual South Florida Residency Seminar
Saturday, January 26, 2013
1
2. Objectives
To provide a background on the implementation and
utilization of Antimicrobial Stewardship Programs (ASPs)
To discuss the role of antimicrobial stewardship in the
healthcare setting
To recognize the IDSA Guideline recommendations and
their impact on pharmacy
To describe the role of pharmacists in antimicrobial
stewardship
To recognize the role of the pharmacist and potential
interventions for providing optimal pharmaceutical care
while shepherding antimicrobial stewardship for the
institution
2
3. “The microbes are educated to resist penicillin and a
host of penicillin-fast organisms is bred out…In such
cases the thoughtless person playing with penicillin is
morally responsible for the death of the man who
finally succumbs to infection with the penicillin-
resistant organism. I hope this evil can be averted.”
Sir Alexander Fleming
New York Times
June 26, 1945
3
4. Timeline leading to Antimicrobial
Stewardship
1990s
1930s • MRSA is
observed in
• Sulfonamides,
penicillin and
1940s 1960s over 53% of
isolates
streptomycin obtained from
became • Staph aureus ICU patients in
available • Penicillin resistance to
resistance to a US
• Harnessing of methicillin surveillance
antibacterial Staph aureus emerges
is detected system
agents for • IDSA/SHEA
clinical use published
begins “Guidelines
for
Antimicrobial
Resistance in
Hospitals”
4
5. Present-day Issues
Multi-drug resistance is a significant issue
resulting increased morbidity, mortality,
and healthcare costs
In 2010, the World Health Organization
recognized antimicrobial resistance as 1 of
the 3 greatest threats to human health
50% of antimicrobial use is inappropriate
Recent decline in the development and
approval of newer antibacterial agents
Increase incidence of Clostridium difficile
associated diarrhea and emergence of
resistance to treatment
5
6. “Antimicrobial resistance is a
global problem,
and antimicrobial stewardship
programs are the global solution.”
Pharmacy Practice News
August 2012
6
7. What is Antimicrobial Stewardship?
“Coordinated interventions designed to improve and
measure the appropriate use of antimicrobial agents
by promoting the selection of the optimal antimicrobial
drug regimen including dosing, duration of therapy,
and route of administration”
The Society for Healthcare Epidemiology of America (SHEA), The Infectious Diseases Society of
America (IDSA) and the Pediatric Infectious Diseases Society (PIDS)
7
8. IDSA/SHEA GUIDELINES FOR DEVELOPING AN
INSTITUTIONAL PROGRAM TO ENHANCE
ANTIMICROBIAL STEWARDSHIP
BACKGROUND CONTENTS
Published in 2007 Executive Summary
Developed and issued on Introduction including the
behalf of the IDSA and purpose and methods of
SHEA guideline development
The development Evidence- based
of effective hospital based Recommendations
stewardship programs Members of ASP Team
All Elements of ASPs
patients in acute care Research and Future
hospitals Directions
8
9. Purpose of Antimicrobial
Stewardship Programs
Goals of Antimicrobial Stewardship Programs (ASPs)
To optimize clinical outcomes while
minimizing unintended consequences of antimicrobial
use
To reduce health-care costs without
adversely impacting quality of care
Benefits of ASPs
Financially self-supporting
Improve patient care
Increases appropriateness of antimicrobial use
Increased clinical cure
9
10. Six Essential Elements
Information Microbiology
Technology Lab
Monitoring of
Supplemental Process and
Strategies Outcome
Measurement
Effective Comprehensive
Active
Antimicrobial Multidisciplinary
Strategies Stewardship Team Approach
10
11. 1. Active Strategies
Prospective audit of Formulary restriction and
preauthorization requirements
antimicrobial use for specific agents
Should include direct
Reduces antimicrobial use and
interaction and verbal or
cost
written feedback to providers
Effectiveness of
May be facilitated through
preauthorization depends on
computer surveillance
the authorizing individual
Utilize the Pharmacy and
Shown beneficial in both large
Therapeutics Committee or
and small hospitals
equivalent group
11
12. 2. Supplemental Strategies
Most frequently employed Development of evidence-
intervention based practice guidelines
that incorporate local
microbiology and
Essential to improving resistance patterns
prescribing behavior
Facilitation of guidelines
Will enhance and increase through education and
acceptance of stewardship feedback
strategies
12
13. 2. Supplemental Strategies
Cycling refers to scheduled Decrease antimicrobial
consumption
removal and substitution
of a specific antibiotic or
Aid in utilization of developed
antibiotic class to prevent guidelines
or reverse resistance
Example forms available on
Insufficient data to CDC website at:
http://www.cdc.gov/getsmart
recommend routine use of /healthcare/improve-
cycling for this purpose efforts/tools.html
13
14. 2. Supplemental Strategies
Insufficient data to Continuing broad therapy
recommend routine use of contributes to selection of
combination therapy to
prevent resistance resistant pathogens
Recommended Use Recommended to use on
Empirical therapy for the basis of culture results
critically ill patients with
MDR pathogens Decreases antimicrobial
Increase breadth of exposure
coverage Substantial cost savings
Increase likelihood of
adequate initial therapy
14
15. 2. Supplemental Strategies
Account for patient Benefits
characteristics, causative Reduced length of hospital
stay
organism, infection site, Decreased healthcare cost
and pharmacokinetic and Reduced incident of
pharmacodynamic complications related to IV
access
characteristics of the drug
May be facilitated by the
development of clinical
Important component to criteria and guidelines
antimicrobial stewardship allowing conversion
15
16. 3. Information Technology
Options Efficient targeting of
Computer Physician Order
Entry (CPOE) antimicrobial interventions
Use of electronic medical
records
Tracking of resistance
patterns
Incorporate data based
computer-identified values
Microbiology C&S Identification of Nosocomial
Hepatic and renal function Infections
Drug-drug interactions
Allergies
Cost
Identification of adverse drug
events
16
17. 4. Microbiology Laboratory
Critical role played in antimicrobial
stewardship
Timely identification of pathogens
Performance of susceptibility testing
Assists infection control efforts in
resistance surveillance
Recommended Responsibilities
Routine Susceptibility testing
Resistance surveillance involvement
• Local antibiograms updated at least
annually
Partner with infection control to
investigate local outbreaks of infection
17
18. 5. Monitoring of Process and
Outcome Measurements
• Did the intervention Useful in determining
Process result in the desired impact of the
Measures change in program on
antimicrobial use? antimicrobial use and
resistance patterns
Investment in data
• Did the process systems to allow for
Outcome implemented reduce evaluation as a
Measures or prevent unintended routine measure of
consequences? quality improvement
18
19. 6. Comprehensive Multidisciplinary
Antimicrobial Management Programs
Antimicrobial stewardship requires a team approach
that incorporates each element simultaneously
Hospital administrative support is essential
Consensus building between administration and
providers should focus on patient safety and care
rather than policing
These programs consistently demonstrate decrease in
antimicrobial use and hospital cost which pays for the
program
19
20. The Stewardship Team
Infectious Diseases Physician
Clinical Pharmacist with ID
Training
Clinical Microbiologist
Information System Specialist
Infection Control Professional
Hospital Epidemiologist
20
21. Recommended for Investigation
Validation that
Heterogeneous Long-term Impact of
Antimicrobial Cycling Antimicrobial Use Formulary Restriction
Slows Resistance and Preauthorization
Spread
Evaluation of The Ability of
Examination of
Approaches that Antimicrobials to
Strategy Efficacy in
Incorporate Many of Cause “Collateral
Subpopulations of
the Most Effective Damage” or
Hospitalized Patients
Strategies Ecological Resistance
Development and
Role of Antimicrobial
Determination of the Validation of
Stewardship
Relative Impact of Automated
Combined with
ASPs on Specific Surveillance Strategies
Infection Control
Resistant Bacteria for Nosocomial
Practices
Infections
21
22. Recommended for Investigation
Decision Support Development and Cost- Strategies to Stimulate
Systems Incorporation effectiveness of more Research and
Antimicrobial rapid and sensitive Development of Novel
Stewardship into CPOE diagnostic tests Antimicrobials
Education and Training
Influence of
of Infectious Diseases
Pharmaceutical Industry
Fellows and Pharmacists
and Representatives on
in Antimicrobial
Antimicrobial Prescribing
Stewardship
22
23. Recent Recommendations
SHEA, IDSA, PIDS April 2012
1. Antimicrobial stewardship programs should be
required through regulatory mechanisms
Recommended that Centers for Medicare and Medicaid
Services require participating healthcare institutions
develop and implement ASPs
CMS should improve programs by requiring additional
activities
2. Antimicrobial stewardship should be monitored in
ambulatory healthcare settings
3. Education about antimicrobial resistance and
antimicrobial stewardship must be accomplished
23
24. Recent Recommendations
SHEA, IDSA, PIDS April 2012
4. Antimicrobial use data should
be collected and readily
available for both inpatient
and outpatient settings
5. Research on antimicrobial
stewardship is needed and
should be funded by the
appropriate federal agencies
24
25. Recent Recommendations
SHEA, IDSA, PIDS April 2012
Recommended Minimum Requirements for ASPs
Multidisciplinary team Additional interventions
including to improve use of
A physician antimicrobials
A pharmacist Processes to measure
A clinical microbiologist and monitoring
An infection antimicrobial use at the
preventionist institutional level
Limited formulary Periodic distribution of a
Institutional guidelines facility-specific
for managing common antibiogram
infection syndromes
25
26. Pharmacist Role in Antimicrobial
Stewardship
“Pharmacists have a responsibility to take prominent
roles in antimicrobial stewardship programs and
participate in the infection prevention and control
programs of health systems”
American Society of Health-System Pharmacists
Position Statement, 2010
26
27. Responsibilities of Pharmacists
Promoting Optimal Use of
Antimicrobial Agents
Reducing Transmission of Infections
Educating Health Professionals,
Patients, and the Public
27
28. Responsibility to Promote
Optimal Use of Antimicrobials
Encourage multidisciplinary Work with laboratory
collaboration personnel to ensure
Work within the P&T appropriate susceptibility
Committee, or equivalent tests are reported in a timely
structure, to ensure the manner
appropriate agents are Work to compile and
available distribute susceptibility
reports at least annually
Operate an ASP that utilizes
patient outcomes to assess Utilize information
effectiveness of policies technology to enhance
stewardship through
Generate and analyze
surveillance
quantitative data on
antimicrobial drug use to Facilitate safe medication
perform outcome analysis management practices
28
29. Responsibility to Reduce
Transmission of Infections
Participate in the infection Encourage routine immunization
prevention and control of staff and those who may
committee impact the patient care
environment
Establish internal pharmacy
Promote adherence to standard
policies, procedures and precautions by those who
quality-control programs to impact the patient care
prevent contamination of environment
pharmacy products Collaborate in the development
Encourage use of single-dose of guidelines for risk assessment,
packages rather than treatment, and monitoring of
multiple-dose containers individuals in contact with a
transmissible infectious disease
Recommend proper labeling,
dating, and storage of sterile Strive for zero-tolerance of
products and their containers health-care associated infections
29
30. Responsibility to Educate Others
Provide educational forums Participate in public health
for healthcare professionals education and awareness
on stewardship-related topics programs aimed and controlling
spread of infectious disease
Antimicrobial use and
resistance Prudent use of antimicrobials
Decontaminating agents Immunization access for
children and adults
Aseptic technique and Appropriate infection
procedures prevention and control
Sterilization methods measures
Educate and counsel patients Provide exposure to
regarding adherence to antimicrobial stewardship and
prescribed directions, storage infection prevention and control
and handling, proper disposal, practices through training for
and other infection control pharmacists, students, residents
and research fellows
procedures
30
31. Review Case
JM is an active 15 year old girl who enjoys playing
softball, swimming and running track. She was initially
presented by her mother to the ER with a temperature
of 103 and complaining of fatigue x 1 week and pain in
her hip.
During the admission her WBC counts
were normal and doctors stated there
were no signs of infection. She was
sent home with a prescription for
ibuprofen and told to follow-up in 3
days.
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32. Review Case
Within 2 days she was brought backed to the ER as her symptoms
seemed to worsen. She was admitted and blood cultures returned
positive for Staphylococcus Aureus. JM was diagnosed with sepsis that
had begun as an abscess growing in her hip.
The infection was accompanied by many
complications including a DVT leading to PE,
and pneumonia requiring intubation.
Eventually, JM developed infections caused by
multiple MDR organisms including ESBL-
producing E. coli, S. Maltophilia, and
Enterobacter aerogenes
The only antibiotic available to treat her infections was colistin. 5
months later, after a lung transplant, suffering a stroke, and losing 30
lbs, JM was discharged home. Her entire stay totaled 6 million dollars
in healthcare costs
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33. Questions to Consider
What roles could antimicrobial stewardship have
played in this case...
To prepare for such a situation prior to admission?
To preventing nosocomial infections during admission?
What future changes could be made to the
hospital’s policy?
What role did or could have pharmacists played
in this case?
Interventions
Patient, family, or provider education
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34. True or False Questions
1. Audits of restrictions and
formularies are
recommended by the IDSA
as key antimicrobial
stewardship activity
2. Antimicrobial stewardship is True False
the practice of using
antimicrobials appropriately
3. Antimicrobial stewardship
does not need to be
monitored in ambulatory
healthcare settings
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35. References
ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and
Infection Prevention and Control. Am J Health-Sys Pharm.2010;67:575-7.
Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of America
and the Society for Healthcare Epidemiology of America Guidelines for Developing
and Institutional Program to Enhance Antimicrobial Stewardship. Clinical
Infectious Diseases, 2007;44:159-177.
Infectious Diseases Society of America. The 10x20 Initiative: pursuing a global
commitment to develop 10 new antibacterial drugs by 2020. Clin Infect Dis
2010;50;1081-1083.
Goff DA, Bauer KA, Mangino JE. “Antimicrobial Stewardship Management of
Infections: Beyond the Cost of Antimicrobials”. Pharmacy Practice News.
McMahon Publishing, August 2012.
Society for Healthcare Epidemiology of America; Infectious Diseases Society of
America; Pediatric Infectious Diseases Society. “Antimicrobial Stewardship Policy
Statement”. Infection Control and Hospital Epidemiology, April 2012; 33(4):322-327.
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