Antimicrobial Stewardship

• Why are antibiotics considered a cornerstone of modern medicine?

  They are essential for the majority of surgical procedures and treatments.
• What types of surgeries rely heavily on antibiotics?

  Orthopaedic, vascular, cancer, cardiac, and neurosurgical surgeries.
• What is the significance of antibiotics in cancer chemotherapy?

  They help manage infections that can arise during treatment.
• How old is antimicrobial resistance (AMR) estimated to be?

  Over 30,000 years old.
• What is the microbiome composed of?

  About 100 trillion microbes.
• What does the term "collateral damage" refer to in the context of antibiotics?

  It refers to the unintended consequences of antibiotic use, such as resistance.
• What is the correlation between human antibiotic use and AMR?

  AMR correlates with human antibiotic use.
• What is the One Health approach in relation to AMR?

  It emphasizes the interconnectedness of human, animal, and environmental health.
• How many deaths were associated with bacterial AMR in 2019?

  1. 95 million deaths.
• What is the highest burden of AMR deaths found?

  In low- and middle-income countries (LMICs).
• What is the risk of death associated with AMR?

  The risk of death doubles with AMR.
• What is the relationship between broad-spectrum antibiotics and Clostridioides difficile infection (CDI)?

  Increased use of broad-spectrum antibiotics correlates with a rise in CDI.
• What is a common consequence of unnecessary antibiotic use?

  It can lead to avoidable toxicity in patients.
• What percentage of hospital patients suffer from antibiotic-associated adverse events?

  One in five hospital patients.
• What is the impact of unnecessary antibiotics on hospital stays?

  They can lead to prolonged hospitalization.
• What does antimicrobial stewardship (AMS) aim to achieve?

  It aims to optimize antibiotic use, minimize harm, and preserve future therapies.
• What are the key components of Antimicrobial Stewardship (AMS)?

  • Monitoring/surveillance
  • Guidelines/protocols
  • Education
  • Specific restrictions
  • Specific interventions
  • Multidisciplinary working
• What does the term "personalize/individualize" refer to in AMS?

  It refers to tailoring antibiotic treatment based on individual patient risk factors.
• What is the purpose of monitoring antibiotic prescribing in AMS?

  To inform guidance and monitor the effect of interventions.
• What is the significance of the "surgical pause" in antibiotic prophylaxis?

  It ensures compliance and monitors outcomes during surgery.
• What are common pitfalls when prescribing antibiotics?

  Prescribing for viral infections and self-limiting conditions.
• What is the main question in empirical guidance in primary care?

  Whether an antibiotic is required or not.
• What should be confirmed before treating asymptomatic bacteriuria in elderly women?

  Confirm urinary symptoms.
• What is the evidence regarding antibiotics in lower respiratory tract infections (LRTI) in primary care?

  Antibiotics are no better than placebo in LRTI.
• What are the steps in antibiotic prescribing?

  1. Is an antibiotic required?
  2. Which antibiotic?
  3. Administer IV or oral?
  4. Dose/interval?
  5. Adjunctive measures?
  6. Duration and IVOST?
  7. Review
• What is the significance of taking a proper history regarding penicillin allergy?

  It helps avoid mislabeling and unnecessary costs associated with antibiotic prescriptions.
• What should be considered when choosing an antibiotic?

  Severity of infection and risk of Clostridioides difficile.
• What is the definition of sepsis?

  Life-threatening organ dysfunction resulting from infection.
• What are the criteria for systemic inflammatory response syndrome (SIRS)?

  Two or more of: heart rate >90 bpm, temperature >38 or <36, respiratory rate >20, WCC >12 or <4.
• What does SIRS not differentiate between?

  Viral or bacterial infections.
• What is the importance of measuring antibiotic prescribing?

  To improve antibiotic use and outcomes.
• What is the role of pharmacy in AMS?

  To ensure the safe use of medication.
• What is the goal of reducing variation in prescribing practice?

  To standardize treatment and improve patient outcomes.
• What is the significance of monitoring compliance and outcomes in surgical prophylaxis?

  It helps ensure the effectiveness of antibiotic use during surgery.
• What is the purpose of delayed antibiotic prescriptions?

  To provide reassurance while allowing for symptom management.
• What is the role of non-antibiotic measures in primary care?

  To provide symptomatic relief and reassurance to patients.
• What is the importance of the "safety netting" approach in antibiotic prescribing?

  It allows for follow-up and reassessment of the patient's condition.
• What is the significance of the "right drug for the bug" principle in AMS?

  It ensures that the antibiotic chosen is effective against the specific pathogen.
• What does the term "empirical treatment" refer to?

  Treatment based on the best guess of the likely infection.
• What is the role of guidelines in AMS?

  To promote efficacy and optimize individual patient care.