Download Free Medical Antimicrobial Stewardship PowerPoint Presentation

Antimicrobial Stewardship PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical PowerPoint presentation titled "Antimicrobial stewardship" by MERIN VARGHESE, MD.

This medical PowerPoint presentation is about antimicrobial stewardship, a set of coordinated strategies and actions aimed at promoting the appropriate use of antimicrobial agents (such as antibiotics, antifungals, and antivirals) in order to minimize the development of antibiotic resistance, reduce healthcare costs, and improve patient outcomes.

The goal of antimicrobial stewardship is to ensure that antimicrobial drugs are used only when they are needed, in the correct dosage and duration, and in a way that minimizes the risk of adverse effects. This involves a multidisciplinary approach, with input from healthcare providers, pharmacists, laboratory personnel, and infection control professionals.

Tags : antimicrobial stewardship, appropriate use of antimicrobial agents, antibiotics, antifungals, antivirals, antibiotic resistance, pharmaceuticals, pharmaceuticals PowerPoint presentations

Published on : Jun 23, 2023 | Views : 2610 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

ANTIMICROBIAL STEWARDSHIP MERIN VARGHESE, MD PHYSICIAN, NGPG INFECTIOUS DISESASE CHAIR AND PHYSICIAN LEAD, NGHS ANTIMICROBIAL STEWARDSHIP COMMITTEE
Slide 2-

NO FINANCIANCIAL DISCLOSURES
Slide 3-

Objectives Define antimicrobial stewardship program Purpose of antimicrobial stewardship program Understanding B-lactam allergies with respect to antimicrobial stewardship
Slide 4-

THE BUGS ARE WINNING…
Slide 5-

Antimicrobial Resistance is a Growing Problem More than 2.8 million antibiotic-resistant infections occur in the U.S. each year. More than 35,000 people die as a result, according to CDC’s 2019 Antibiotic Resistance Threats Report. The estimated national cost to treat infections caused by six multidrug-resistant germs frequently found in health care can be substantial—more than $4.6 billion annually https://www.cdc.gov/drugresistance/national-estimates.html
Slide 6-

ANTIMICROBIAL RESISTANCE
Slide 7-

ppt slide no 7 content not found
Slide 8-

SHARING THE RESTISTANCE
Slide 9-

SHARING THE RESISTANCE
Slide 10-

HOW ANTIMICROBIAL RESISTANCE SPREADS https://www.cdc.gov/narms/faq.html
Slide 11-

ANTIMICROBIAL RESISTANCE THREATS
Slide 12-

BUGS FIGHTING BACK
Slide 13-

ANTIMICROBIAL STEWARDSHIP Per Infectious Disease Society of America (IDSA) – Antimicrobial stewardship is an activity that promotes Appropriate selection of antimicrobials Appropriate dosing of antimicrobials Appropriate route and duration of antimicrobial therapy
Slide 14-

GOALS OF ANTIMICROBIAL STEWARDSHIP What is antimicrobial stewardship? Antibiotic stewardship refers to a set of commitments and activities designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The goal is… to have the RIGHT DRUG for the RIGHT PERSON over the RIGHT TIME FRAME AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI
Slide 15-

GOALS OF ANTIMICROBIAL STEWARDSHIP Primary goal Optimize clinical outcomes while minimizing unintended consequences of antimicrobial use Unintended consequence Toxicity Selection of pathogenic organisms such as C. difficile Emergence of resistant pathogens Secondary goal Reduce healthcare costs without adversely impacting the quality of care
Slide 16-

PREVENT ANTIMICROBIAL RESISTANCE AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Infection prevention IS antimicrobial stewardship! Tracking infection prevention data has double value Hospital acquired infection prevention Informs antibiotic stewardship programs Improving antibiotic prescribing Bacteria are constantly evolving, requiring the need for new antibiotics Source: Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.
Slide 17-

WE MUST WORK TOGETHER… Working relationship between infection control and antimicrobial management. Selection of antimicrobials from each class of drugs that does the LEAST collateral damage Collateral damage Methicillin-resistant Staphylococcus aureus Extended spectrum B-lactamase (ESBL) Clostridioides difficile (C. difficile) Vancomycin-resistant enterococci (VRE) Metalloenzymes & other carbapenemases Appropriate de-escalation when culture results are available
Slide 18-

DRUGS CAN’T KEEP UP
Slide 19-

NGHS ASP Structure Reports to: Pharmacy & Therapeutics Committee Infection Control Committee NGMC Quality Committee Acute Care Campuses Gainesville Braselton Barrow Lumpkin Skilled Nursing Limestone Lanier Park Outpatient NGPG Urgent Care NGPG Clinics
Slide 20-

TODAY’S FOCUS What is antimicrobial stewardship? Antibiotic stewardship refers to a set of commitments and activities designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The goal is… to have the RIGHT DRUG for the RIGHT PERSON over the RIGHT TIME FRAME
Slide 21-

TODAY’S FOCUS Penicillin allergy
Slide 22-

PENICILLIN ALLERGY Up to 10% of the general population and 15% of hospitalized patients list penicillin as an allergy.
Slide 23-

PENICILLIN ALLERGY https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf
Slide 24-

PENICILLIN ALLERGY Penicillin “allergic” patients are more likely to Received fluroquinolones, vancomycin, clindamycin Harbor drug resistant organisms such as MRSA and VRE Develop C diff colitis Increased mortality Experience -- treatment failure, infection recurrence, death from MSSA bacteremia treatment failure in gram negative bacteremia a delay in empiric antimicrobial treatment a surgical site infection
Slide 25-

PENICILLIN ALLERGY Pencillin “allergic” patients are more likely to Develop new antibiotic “allergies” with alternative therapies Have an allergic reaction to vancomycin than cefazolin Have side effects or toxicities from second-line therapies
Slide 26-

PENCILLIN ALLERGY Penicillin allergic patients have higher drug costs Higher outpatient antibiotic costs per patient $300 more per patient per day of inpatient antibiotic therapy $1253 more in length of stay costs per patient per admission Penicillin allergic patients have longer hospital stays 10% longer hospital stays, estimated cost of $21.5 million per year.
Slide 27-

PENICILLIN ALLERGY: ACCURATE DIAGNOSIS? Less than 10% of these allergies are confirmed when tested Childhood viral rashes are often misdiagnosed as drug rashes Only 7-16% of kids with “drug allergy” during an infection later test positive to the drug. Even if a patient is truly allergic, most people “outgrow” penicillin allergy Over 50% of people with confirmed allergy to penicillin ‘lose their allergy’ after 5 years Over 80% will lose it in 10 years
Slide 28-

BETA LACTAMS
Slide 29-

CEPHALOPSORIN VS PENICILLIN Overall cross-reactivity based on multiple studies is actually very low: Reported (but unconfirmed) penicillin allergy: 0.1% Confirmed penicillin allergy: 2% Above exclude patients with penicillin anaphylaxis
Slide 30-

PENICILLIN ALLERGY
Slide 31-

OUR EFFORTS Cascading susceptibilities Drug desensitization Drug challenge
Slide 32-

Cascading Susceptibilities Definition a strategy of reporting antimicrobial susceptibility test results in which secondary (e.g., broader-spectrum, more costly) agents may only be reported if an organism is resistant to primary agents within a particular drug class
Slide 33-

Old New
Slide 34-

Graded Challenge/Test Doses 1%/10%/20% Monitoring Vital signs every 30 minutes Rescue meds available (diphenhydramine, epinephrine, methylprednisolone) Update allergy profile after challenge
Slide 35-

Graded Challenge (GC)
Slide 36-

Desensitization Monitoring Requires 1:1 nursing ratio ICU admission likely required Airway box at bedside Vital signs every 30 minutes Rescue meds available (diphenhydramine, epinephrine, methylprednisolone) Desensitization establishes a temporary tolerance so allergy on profile is relevant and should remain there 18 step process
Slide 37-

Desensitization
Slide 38-

Graded Challenge vs Desensitization Solensky. Immunol Allergy Clin N Am 24 (2004) 425–443 Solensky. Ann Allergy Asthma Immunol 2010;105:259
Slide 39-

Is The Risk Worth It? Risk of life-threatening reaction to beta lactams in those with reported allergies – very low if they are screened for mild reactions and antimicrobials are chosen carefully. With the use of LIFE THREATENING infection - MUCH HIGHER when ALTERNATIVE agents are used. C. difficile colitis kills about 29,000 per year Fatal drug induced anaphylaxis (1999-2010) – antibiotics were identified as culprits in 585 deaths (12 year period). https://www.sciencedirect.com/science/article/pii/S0091674914011907?via%3Dihub
Slide 40-

THANK YOU
Slide 41-

REFERENCES Cdc.gov https://www.sciencedirect.com/science/article/pii/S0091674914011907?via%3Dihub Solensky. Immunol Allergy Clin N Am 24 (2004) 425–443. Solensky. Ann Allergy Asthma Immunol 2010;105:259 https://www.publichealthontario.ca/apps/asp-strategies/data/pdf/ASP_Strategy_Cascading_Microbiology_Reporting.pdf https://www.researchgate.net/figure/The-Partners-Penicillin-and-Cephalosporin-Hypersensitivity-Pathway-These-pathway_fig2_316781890 https://www.ryah.ca/2014/09/29/animal-health-week-antibiotic-responsible-and-appropriate-use/ https://www.istockphoto.com/illustrations/antibiotic-resistance http://love-life-science.blogspot.com/2014/09/bacterial-gifts.html?spref=pi