Lecture 4.2 - Antimicrobial resistance and stewardship

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Questions and Answers

What percentage of antibiotic prescribing occurs in the community in the UK?

60%

80% (correct)

50%

90%

What is the primary goal of Antimicrobial Stewardship Programs?

Achieving optimal clinical outcomes related to antimicrobial use (correct)

Minimising toxicity and other adverse events

Promoting the use of broad-spectrum antibiotics

Reducing the costs of healthcare for infections

What is the consequence of prolonged antibiotic use in the community for urinary tract infections?

Increased rates of carriage of resistant bacteria for up to 12 months (correct)

Increased risk of Clostridioides difficile infection

Increased risk of fungal infections

Increased risk of antibiotic-associated diarrhoea

What is the estimated percentage of antibiotic use in humans and animals that is unnecessary and inappropriate?

Up to half Signup and view all the answers

What is the primary mechanism behind the spread of NDM?

Horizontal gene transfer Signup and view all the answers

What is the key component of Antimicrobial Stewardship Programs?

Coordinated interventions to improve antibiotic use Signup and view all the answers

What is the primary consequence of antibiotic misuse in the community?

Increased rates of carriage of resistant bacteria Signup and view all the answers

What is the primary goal of limiting antibiotic use in humans and animals?

Limiting the selection for antimicrobial resistant strains Signup and view all the answers

What is the primary reason why GPs prescribe antimicrobials?

To alleviate patient symptoms and worry about complications Signup and view all the answers

What is a key component of a stewardship program?

Multidisciplinary team (MDT) collaboration Signup and view all the answers

What is the primary goal of outcome measures in antimicrobial stewardship?

To evaluate the effectiveness of stewardship interventions Signup and view all the answers

What type of stewardship intervention is most effective in reducing antibiotic use?

Combination of persuasive and restrictive interventions Signup and view all the answers

What is the primary benefit of delayed antibiotic prescribing?

Reducing antibiotic side effects Signup and view all the answers

What is the key element of discussing antibiotics with patients?

Discussing the reasons for delayed antibiotic prescribing and specific number of days to wait Signup and view all the answers

What is the primary goal of the TARGET booklet?

To promote antibiotic stewardship and responsible use Signup and view all the answers

What percentage of the public is in favor of delayed antibiotic prescriptions?

60-70% Signup and view all the answers

What is the primary goal of antibiotic stewardship programs?

To reduce the development of antibiotic resistance Signup and view all the answers

Which of the following is an example of ecological study?

A study that relates levels of antibacterial use in a population with levels of resistance Signup and view all the answers

What is the definition of XDR (extensively drug resistant)?

Non-susceptibility to at least one agent in all but two or fewer antimicrobial categories Signup and view all the answers

What is the relationship between antibiotic use and resistance according to the casual relationship?

Antimicrobial use ------> increase in resistance Signup and view all the answers

What is the definition of MDR (multi-drug resistant)?

Non-susceptibility to at least one agent in three or more antimicrobial categories Signup and view all the answers

What type of study provides biological plausibility for the relationship between antibiotic use and resistance?

Laboratory evidence Signup and view all the answers

What is the purpose of antibiotic stewardship programs in the context of infection prevention and control?

To reduce the development of antibiotic resistance and prevent the spread of resistant infections Signup and view all the answers

What type of study relates prior antibacterial use in an individual with the subsequent presence of bacterial resistance?

Individual level data Signup and view all the answers

Study Notes

Antibiotic Resistance

MDR (multi-drug resistant): non-susceptibility to at least one agent in three or more antimicrobial categories
XDR (extensively drug resistant): non-susceptibility to at least one agent in all but two or fewer antimicrobial categories
PDR (pan-drug resistant): non-susceptibility to all agents in all antimicrobial categories

Antibiotic Use and Resistance

The use of antibiotics results in resistance
Antibiotic stewardship is dependent on the casual relationship between antimicrobial use and resistance
Evidence of resistance includes:
- Laboratory evidence providing biological plausibility
- Ecological studies relating antibacterial use to resistance levels
- Individual level data relating prior antibacterial use to subsequent bacterial resistance

Ecological Studies

Relationship between prior antimicrobial use and resistance in Streptococcus pneumoniae in Finland (1997-2002)
- Regional rates of consumption of penicillins, cephalosporins, and macrolides estimated from sales figures
- Macrolide and azithromycin use associated with increased macrolide resistance on a regional level
- Beta-lactam and cephalosporin use associated with increased rates of low-level penicillin resistance

Individual Level Data

Systematic review and meta-analysis of relationship between prior antibacterial exposure and resistance in individual patients in primary care
- 24 studies reviewed
- Antibiotics prescribed for urinary tract infections linked to increased rates of carriage of resistant bacteria in recipient patients for up to 12 months
- Longer durations and multiple courses associated with higher resistance rates

Antimicrobial Stewardship

Definition: Coordinated interventions designed to improve and measure the appropriate use of antimicrobials
Goals: Optimal clinical outcomes, minimize toxicity, reduce healthcare costs, and limit the selection of antimicrobial resistant strains
Up to half of antibiotic use in humans and animals is unnecessary and inappropriate
Stopping inappropriate and unnecessary use of antibiotics would help slow down the spread of resistant bacteria

Antibiotic Prescribing

80% of antibiotics are prescribed in general practice
Reasons for prescribing antibiotics: relief of symptoms, worry about complications, and patient pressure

Elements of Stewardship Programme

MDT (Multidisciplinary Team)
Surveillance:
- Process measures: antibacterial use (quantity, type, appropriateness), benchmarking within and between organizations
- Outcome measures: patient outcomes, emergence of resistant organisms
Interventions:
- Persuasive
- Restrictive
- Structural

Effective Stewardship

Evidence of effectiveness of stewardship programs in reducing antibiotic resistance
Clinical scenario: acute sore throat
Patient perspective: understanding and accepting back-up/delayed antibiotic prescriptions
TARGET: Treat Antibiotics Responsibly Guidance, Education and Tools booklet

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Description

Learn about the different types of antibiotic resistance, including MDR, XDR, and PDR, and how antibiotic use contributes to resistance. Understand the importance of antibiotic stewardship.