This presentation discusses implementing an antimicrobial stewardship program in hospitals. It recommends starting with formulary restriction, preauthorization, and prospective audits with feedback. Additional strategies include education, clinical guidelines based on local data, and streamlining antibiotic therapy. The presentation emphasizes developing customized treatment protocols based on the hospital's own microbiology data to promote evidence-based antibiotic usage. It provides a framework for compiling local infection and antibiotic sensitivity data, risk stratifying patients, and suggesting empiric therapies with options for de-escalation.
What are some of the challenges in pharmacovigilance? This presentation offers you more information on signal detection, signal management and risk minimisation measures.
What are some of the challenges in pharmacovigilance? This presentation offers you more information on signal detection, signal management and risk minimisation measures.
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.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
Role of PK PD in Antibiotic Stewardship Program with case study. This presentation gives an comprehensive overview about role of PK PD in antibiotic stewardship program.
Microbiology is the study of microorganisms.
The overall theme of the Microbiology course is to study the relationship between microbes and our lives.
Microorganisms (microbes) are organisms that are too small to be seen with the unaided eye, and usually require a microscope to be seen.
This relationship involves harmful effects such as diseases and food spoilage as well as many beneficial effects.
ABCs in EIDs: Preparing for Emerging Infectious DiseasesArthur Dessi Roman
With the imminent threat of emerging infectious diseases in our midst, Dr. Arthur Dessi Roman provides a step by step guide on how institutions can prepare for these EIDs.
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.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
Role of PK PD in Antibiotic Stewardship Program with case study. This presentation gives an comprehensive overview about role of PK PD in antibiotic stewardship program.
Microbiology is the study of microorganisms.
The overall theme of the Microbiology course is to study the relationship between microbes and our lives.
Microorganisms (microbes) are organisms that are too small to be seen with the unaided eye, and usually require a microscope to be seen.
This relationship involves harmful effects such as diseases and food spoilage as well as many beneficial effects.
ABCs in EIDs: Preparing for Emerging Infectious DiseasesArthur Dessi Roman
With the imminent threat of emerging infectious diseases in our midst, Dr. Arthur Dessi Roman provides a step by step guide on how institutions can prepare for these EIDs.
The evolution of antimicrobial resistance: a Darwinian perspectiveThe Royal Institution
Sir Richard Sykes presented this Friday Evening Discourse at the Royal Institution of Great Britain on Friday 6 May 2011.
Microbes have evolved over 3.5 billion years and are arguably the most adaptable organisms on earth. Restricted genetically by their inability to reproduce sexually, bacteria have acquired several additional mechanisms by which to exchange genetic material. Such mechanisms have allowed bacteria to inhabit some of the most inhospitable environments on earth. It is then hardly surprising that when faced with a barrage of inimical chemicals (antibiotics) they have responded with an equal and opposite force.
Sir Richard compared and contrasted the evolution of antimicrobial resistance to B-lactam antibiotics over the last 70 years in two bacterial species, namely Staphylococcus aureus, a highly evolved human pathogen, and Pseudomonas aeruginosa, an opportunistic nosocomial pathogen.
Find out more at www.rigb.org
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
Antimicrobial Resistance Surveillance and Management in Hospital and Community Settings - Issues for Human Population Medicine - Dr. Kurt Stevenson, The Ohio State University Medical Center, from the 2012 NIAA One Health Approach to Antimicrobial Resistance and Use Symposium, October 26-27, 2012, Columbus, OH, USA.
More presentations at:
http://www.trufflemedia.com/agmedia/conference/2012-one-health-to-approach-antimicrobial-resistance-and-use
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Antibiogram of Bacterial Isolates at Hail General Hospital, KSA June 1 – Dece...iosrjce
This research study focused on the antibiogram of bacterial isolates at Hail General Hospital,
Kingdom of Saudi Arabia. It sought to answer the following questions: (1) What is the percentage distribution of
the isolates on the specimens when classified according to the following bacteria? Enterobacter aerogenes,
Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus spp., Pseudomonas aeruginosa,
Raoultella (K.) ornithinolytica. (2) What is the antibiogram result of the bacterial isolates? Descriptive research
using content analysis was employed wherein the Automated Sensitivity Testing Machine data obtained from the
Microbiology section of Hail General Hospital. The statistical tools were frequency and percentage. The results
revealed that based on the percentage distribution of the specimens, the highest number of isolates for
Enterobacter aerogenes, Enterobacter cloacae, Klebsiella pneumoniae and Proteus spp. was from throat swab,
urine for Escherichia coli and Psedomonas aeruginosa, ward swab and high vaginal swab for Raoultella (K.)
ornithinolytica. On antibiogram result, the most sensitive antibiotics for Enterobacter aerogenes was
Meropenem; Cirpofloxacin and Levofloxacin for Enterobacter cloacae; Imipenem for Escherichia coli;
Amikacin for Klebsiella pneumoniae; Ertapenem, Imipenem and Pip/Tazo for Proteus spp.; Pip/Tazo for
Pseudomonas aeruginosa, and Imipenem for Raoultella (K.) ornithinolytica. The most resistant antibiotics for
Enterobacter aerogenes, Escherichia coli, Klebsiella pneumonaie and Raoultella (K.) ornithinolytica was
Ampicillin; Amox/K Clav, Cefazolin and Cefoxitin for Enterobacter cloacae; Cefotaxime for Pseudomonas
aeruginosa and for Proteus spp. was Cefazolin. The researchers recommend for the conduct of an annual
antibiogram study by institution, disseminate the information through seminars/fora especially to clinicians,
conduct another study to include other hospitals and other types of bacteria.
This study was designed to investigate the infection rate of nosocomial Acinetobacter spp. in Khalifa hospital, Ajman. A retrospective study was carried out from 2005 to 2008. Bacteriological cultures were used to isolate the organisms by the DADE BEHRING Microscan® to identify the organisms and their antibiotic sensitivity.
ANTIMICROBIAL RESISTANCE PATTERNS AMONG ACINETOBACTER BAUMANNII ISOLATED FROM...inventionjournals
Acinetobacter baumannii (Ab) is a troublesome and increasingly problematic healthcareassociated pathogen, especially in critical care unit (ICU) and cardiovascular internal medicine (CIM). This organism has a capacity for long-term survival in the hospital environment. This study aimed to investigate the drug resistance patterns of Ab strains isolated from Thongnhat Dongnai General Hospital and the relationships between Ab isolations with clinical wards and year of patients. The antibiotic susceptibility of 279 Ab isolates for aminoglycosides, fluro-quinolons, cephalosporins, carbapenems, colistin and bactrim was determined using Kirby-Bauer disk diffusion method. The minimum inhibitor concentration (MIC) of 146 Ab isolates for Meropenem was determined using E-test method according to CLSI guide-line. A total 279 A. baumannii strains out of 1,976 positive isolates were collected from various specimens during study period. Among Ab-positive specimens, the most isolated specimen was sputum (26.6%, χ 2 =161.705 p<0.000),><0.000)><0.000),><0.000). Among 279 Ab isolated, resistance from 53.16% – 63.52% to aminoglycosides, 23.6% – 68.58% to fluroquinolons, 59.61% to 97.93% to cephalosporins, 60.27% to 80.7% to carbapenem, 10.53% to 66.48% to antibiotic combinations, 0.75% to colistin and 61.71% to bactrim. Among 146 multidrug-resistant Ab, 53.42% MICmeropenem ≥ 32 μg/ml and only 18.49% strains were susceptible to Meropenem. Due to the high antimicrobial resistance to two clinical wards (ICU and CIM) and carbapenems by disk agar diffusion test and E-test; we must focus on both a wiser use of antimicrobials and the prevention of infection. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future.
ANTIMICROBIAL RESISTANCE PATTERNS AMONG ACINETOBACTER BAUMANNII ISOLATED FROM...inventionjournals
Acinetobacter baumannii (Ab) is a troublesome and increasingly problematic healthcareassociated pathogen, especially in critical care unit (ICU) and cardiovascular internal medicine (CIM). This organism has a capacity for long-term survival in the hospital environment. This study aimed to investigate the drug resistance patterns of Ab strains isolated from Thongnhat Dongnai General Hospital and the relationships between Ab isolations with clinical wards and year of patients. The antibiotic susceptibility of 279 Ab isolates for aminoglycosides, fluro-quinolons, cephalosporins, carbapenems, colistin and bactrim was determined using Kirby-Bauer disk diffusion method. The minimum inhibitor concentration (MIC) of 146 Ab isolates for Meropenem was determined using E-test method according to CLSI guide-line. A total 279 A. baumannii strains out of 1,976 positive isolates were collected from various specimens during study period. Among Ab-positive specimens, the most isolated specimen was sputum (26.6%, χ 2 =161.705 p<0.000),><0.000)><0.000),><0.000). Among 279 Ab isolated, resistance from 53.16% – 63.52% to aminoglycosides, 23.6% – 68.58% to fluroquinolons, 59.61% to 97.93% to cephalosporins, 60.27% to 80.7% to carbapenem, 10.53% to 66.48% to antibiotic combinations, 0.75% to colistin and 61.71% to bactrim. Among 146 multidrug-resistant Ab, 53.42% MICmeropenem ≥ 32 μg/ml and only 18.49% strains were susceptible to Meropenem. Due to the high antimicrobial resistance to two clinical wards (ICU and CIM) and carbapenems by disk agar diffusion test and E-test; we must focus on both a wiser use of antimicrobials and the prevention of infection. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future
Automation in microbiology, changing concept and defeating challengesAyman Allam
A presentation about the automation in microbiology presented in 24th conference of the Egyptian Society of Medical Microbiology and immunology, 4/2017.
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
1. This presentation was presented at Apollo
International Forum on Infection Control
(AIFIC’ 2013), Chennai
The presentation is solely meant for Academic
purpose
3. Guiding Document for Antimicrobial stewardship
Infectious Diseases Society of America and the
Society for Healthcare Epidemiology of America
Guidelines for Developing an Institutional Program to
Enhance Antimicrobial Stewardship
Clinical Infectious Diseases 2007;44:159-77
4. Antimicrobial Stewardship Strategies
Primary:
Formulary restriction and preauthorization (BII) Can this be the
starting point in
Prospective audit with intervention and feedback.(AI) India ?
Secondary:
Education.(AII)
Guidelines and clinical pathways (AI)
Streamlining or de-escalation of therapy.(AII)
5. AMS Simplified
4 D’s of Antibiotics
The Right Drug
The Right Dose
The Right Duration
De-escalation
Glynn etal. Current Anaesthesia & Critical Care (2005) 16, 221–230
6. Antimicrobial Stewardship – Indi(a)genous!
Education.(AII)
Guidelines and clinical pathways based on local data (AI)
Streamlining or de-escalation of therapy.(AII)
To Educate and Promote Evidence based usage of antibiotics by
making Customized treatment protocols based on the hospital’s
own Microbiology data
Prospective audit with intervention and feedback.
Formulary restriction and preauthorization
7. Principles for Making Antibiotic Protocols
Site of Infection
Risk stratification for MDRs
Local microbiology data
De-escalation
8. Step 1:
Compile Local Hospital data
Based on site of infection Organism spectrum in general wards (Jan-Jun 2006)
Steno E.coli
Pneumoc 0.3% Burkhol Staph
– Geographic Variations 0.3% 0.3% Salmonela
Candida Kleb
( ICUs / Wards / Surgical 6%
2% E.coli Proteus
Site Infections etc.)
35% Enteroc
Pseudo
19% Acineto
1. % Distribution of Bugs Pseudo
Acineto
Candida
1%
Staph Pneumoc
1. % Susceptibility of Enteroc Proteus Kleb 7% Steno
antibiotics 5% 4% 20%
Burkhol
Salmonela
9. Step 2: Putting data in Toolkit making antibiograms
- The data needed for last 6 months ( minimum 3 months)
- Ward and ICU isolates data for Blood Stream Infections, Pneumonias,
IAIs, SSTIs and UTIs.
- User Friendly Tool kit to put in data based on Site of Infection
- Tool kit will be separate for Ward and ICU isolates
-Tool kit contains 5 most common pathogens, and most antibiotics in
decreasing order of sensitivity
- Tool kit will also contain the Validity period
Hospital surveillance data (Usually last 6 months) Validity of these data: Next one year (Max)
S. No Most common pathogens % prevalence S. Most sensitive antibiotics
No. pathogens in descending order.
1 1
2 2
3 3
4 4
5 5
10. Example of Toolkit containing
Antibiogram for Blood culture
Hospital surveillance data(Jan-10 till Dec 10) Validity of these data: Dec-2011
S. Most common % Most sensitive antibiotics
No
pathogens prevalence (% Sensitivity)
1 Pseudomonas 30% Colistin (98%) Imi (85%) Cef/Sul (79%) *Pip/Taz
(62%) *Amikacin (57%)
2 Klebsiella 25 % Imipenem (93%) Ertapenem (92%)
*Cef/Sul(76%) *Amikacin = Pip/Taz (65%)
3 Acinetobacter 14 % Colistin (98%) Cef/Sul (85%) Imipenem (82%)
*Pip/Taz(45%)
4 E.Coli 12 % Imipenem (95%) Ertapenem (94%) Cef/Sul (79%)
*Amikacin (70%) *Pip/Taz (67%)
5 Staph Aureus 9% Vancomycin (97%) *Ertapenem = Cef/Sul =
Pip/Tazo (70%)
Note: Cut off value to be used as empiric antibiotic is 80%
*Choices written in white have sensitivity less than 80%
11. Step -3. Patient types based on Risk stratification
Type 1 Type 2 Type 3
Health Care Contact No Yes Prolonged
Procedures No Minimum Major invasive
Procedures
Antibiotic Rx History No in last 90 days Yes in last 90 days Repeat multiple
antibiotics.
Patients Young – No co- Elderly
Characteristics morbid conditions. Few Co-morbid Immunocompromised,
conditions. or with many co-
morbid conditions.
Causative Pathogen Susceptible to ESBLs ESBLs /
could be Common narrow Pseudomonas
spectrum /Acinetobacter
antibiotics MRSA
Possible Antibiotic - No Need for - Use Non- - Use Anti-
recommendations Broad spectrum Pseudomonal pseudomonal
antibiotics broad spectrum Broad spectrum
antibiotics antibiotics
Ref: Based on stratification criteria suggested by Dr Yehuda Carmelli Slide 18
12. Step 4: De-escalation
Discontinuate /Taper down antibiotics if negative
cultures and patient improving
Diminish the number of antibiotics.
Shorten length of duration of antibiotics.
Narrow spectrum of antibiotics.
13. Antimicrobial Stewardship brings hospital specific protocols
to the patient bedside to enable evidence based treatment
Specific
Indication
Hospital specific
microbiology data
Patient risk
stratification
Options for Empiric
therapy and De-
escalation
14. AMS Update from India - 2013
- Golden Peacock award for AMS
in 2012 101 protocols (71hospitals) completed YTD
-Expanding this AMS model in other
countries (Vietnam, Russia, S Africa)
Indian society for critical care medicine
(ISCCM).
AMS Workshops on AMS organized in annual
Update ISCCM meeting for last 4 years
2012
The proposed national antibiotic policy MSD India – the one representative from
prepared by the Government of India pharmaceutical industry to highlight efforts on AMS
in 2011 also recommends a hospital during the 1st Global forum on antibiotic resistance
model of antimicrobial stewardship on organized by SHEA, the PHFI and the CDDEP in
similar lines as this programme on New Delhi on Oct 3-5,2011
AMS
16. Proposed Outcome measures for AMS
Domain of Impact Indicator
Nosocomial infection Rate Incidence of nosocomial infections
Resistance pattern Proportion (%) of resistant isolates
- ESBL
- MRSA
- Pseudomonas/ carbapenem
Average length of stay in ICU Reduction in LOS
Prescription practices Reduction in rate of inappropriate prescription
practices
Utilization / Consumption of antibiotics Defined daily dosages (DDD)
Duration of antibiotic therapy Reduction in duration of antibiotic therapy
Mortality rates Reduction in mortality rates before and after
intervention
Cost of treatment Reduction in per unit cost of therapy
17. Drug Resistance Index (DRI)
DRI calculation
(Antibiogram +
DDD/100Bed days)
in progress
18. Strengths of AMS Initiative
• Simple (yet not simplistic !)
• Evidence Based
• User friendly
• Democratic (OF the hospital, BY the hospital
and FOR the hospital)