Antimicrobial Stewardship

What is antimicrobial stewardship

Organisational or healthcare system wide approach to promoting and monitoring the use of antimicrobials to preserve their future effectiveness

4 step antibiotic resistance

1. lots of germs with a few drug resistant

2. Abx kill bacteria causing the illness as well as good bacteria

3. The drug resistant bacteria are now allowed to grow and take over

4. Some bacteria give their drug resistance to other bacteria causing further problems

Prevention

Hand washing

Food preparation

Vaccinations

Movement

What can diabetics do to help prevent infections

Diabetics - wound care! preventative dietary, blood pressure under control, diabetic medication (can increase urine)

Elderly population - risk group

Pressure ulcers - continence caring and movement

osteomyelitis

prostate - catheter - does it fit, nurses appropriately trained

Respiratory patient

Risk of chest infections

reduce by cough clearance, sat upright majority of day, breathing deeply

Most common causes for antibiotics

Chest infections, upper respiratory tract infections

Start smart then focus

Often broad and then narrow

RIGHT antibiotic choice

Right Choice - specific infection

Right Dose - optimum effect

Right Route - patient/infection site/bacteria

Right frequency - maintain appropriate PK

Right Duration - long enough to treat infection but not too long to cause resistance

Suspected SEPSIS

Antibiotics within first 3 hours

how are guidelines written

90% likelihood of the infection such as local areas

what drug factors would you consider

Spectrum

penetration

evidence allergies

Site Factors

Likely bacteria

Risk factors

allergies

What does data often lack

obese

underweight

renal

HF

ICU

SEPSIS

Key parameter for antimicrobial stewardship in hospital

IV to oral switch C

Considerations for discharges

Completing the course

Sensitivities - bacteria’s

Interactions

Distribution through adipose tissues

Dose Prevention