24 Questions
What percentage of antibiotic prescribing occurs in the community in the UK?
80%
What is the primary goal of Antimicrobial Stewardship Programs?
Achieving optimal clinical outcomes related to antimicrobial use
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
What is the estimated percentage of antibiotic use in humans and animals that is unnecessary and inappropriate?
Up to half
What is the primary mechanism behind the spread of NDM?
Horizontal gene transfer
What is the key component of Antimicrobial Stewardship Programs?
Coordinated interventions to improve antibiotic use
What is the primary consequence of antibiotic misuse in the community?
Increased rates of carriage of resistant bacteria
What is the primary goal of limiting antibiotic use in humans and animals?
Limiting the selection for antimicrobial resistant strains
What is the primary reason why GPs prescribe antimicrobials?
To alleviate patient symptoms and worry about complications
What is a key component of a stewardship program?
Multidisciplinary team (MDT) collaboration
What is the primary goal of outcome measures in antimicrobial stewardship?
To evaluate the effectiveness of stewardship interventions
What type of stewardship intervention is most effective in reducing antibiotic use?
Combination of persuasive and restrictive interventions
What is the primary benefit of delayed antibiotic prescribing?
Reducing antibiotic side effects
What is the key element of discussing antibiotics with patients?
Discussing the reasons for delayed antibiotic prescribing and specific number of days to wait
What is the primary goal of the TARGET booklet?
To promote antibiotic stewardship and responsible use
What percentage of the public is in favor of delayed antibiotic prescriptions?
60-70%
What is the primary goal of antibiotic stewardship programs?
To reduce the development of antibiotic resistance
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
What is the definition of XDR (extensively drug resistant)?
Non-susceptibility to at least one agent in all but two or fewer antimicrobial categories
What is the relationship between antibiotic use and resistance according to the casual relationship?
Antimicrobial use ------> increase in resistance
What is the definition of MDR (multi-drug resistant)?
Non-susceptibility to at least one agent in three or more antimicrobial categories
What type of study provides biological plausibility for the relationship between antibiotic use and resistance?
Laboratory evidence
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
What type of study relates prior antibacterial use in an individual with the subsequent presence of bacterial resistance?
Individual level data
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
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.
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