DOING STEWARDSHIP

Question 1

AMR is a global problem

T/F

Answer 1

T

Question 2

AMR is a consequence of __________ or __________ of __________

Answer 2

misuse

overuse

antimicrobials

Question 3

Antibiotic therapy

Clear clinical and bacteriological diagnosis

__________ therapy
__________ therapy
__________

Answer 3

Definitive therapy
Empiric therapy
Prophylaxis

Question 4

Definitive therapy

Based on _________________ after ______________
Based on ________ of __________________ testing

Answer 4

microbial diagnosis

full investigation

results

antibiotic sensitivity

Question 5

Empiric therapy
Therapy based on
– ______________ and
– bacteriologic _________

Application of knowledge of the organisms most likely to cause infections in a given clinical setting

Answer 5

clinical judgment

bacteriologic statistics

Question 6

Guide to empiric therapy

____________- body fluids, buffy coat, sputum

________ methods -Elisa, Latex agglutination

Bacteriologic _________ (incorporated in ________________)

__________ e g procalcitonin, c- reactive protein

Answer 6

Gram stain ; Immunologic

statistics ;antibiotic guidelines

Biomarkers

Question 7

Chemoprophylaxis
__________ of infection by administration of antimicrobial agents

– There are specific indications for prophylaxis

Answer 7

Prevention

Question 8

Principles

1._________ of infection
2. Infection unlikely/likely to _____________
3. Relevant specimens before treatment 4. Which ______?
5. _______ factors

Answer 8

Evidence

respond to treatment

drug

Host factors

Question 9

Antibiotic Sensitivity testing
Methods
________ diffusion
________ dilution
________ dilution
________ gradient

Answer 9

Disk diffusion
Agar dilution
Broth dilution
Agar gradient

Question 10

MIC is the????

Answer 10

Minimum concentration of antibiotic required to inhibit the organism

Question 11

Which drugs
________ spectrum drug
Knowledge of the _______ of __________
Pharmacodynamic characteristics Patient factors - ______-____ -________

Answer 11

Narrow spectrum

site of infection

allergy ; age

pregnancy

Question 12

Antibiotic use documents

Antibiotic __________
Antibiotic __________

Answer 12

guidelines

policies

Question 13

Antimicrobial stewardship - definition

Refers to coordinated _________ designed to improve and measure the _______________ of ______________ by promoting the selection of _______ antibiotic drug regimens including _______ , _______ of therapy and ____________

Answer 13

interventions

appropriate use

antimicrobial agents ; optimal

dosing ; duration

route of administration

Question 14

Goals of ASPs
_________ antimicrobial therapy
Reduce treatment related _______
Minimise _________ events
Decrease the risk of development of ________________

Answer 14

Optimise ; costs

adverse

antimicrobial resistance

Question 15

Reduce antimicrobial costs

By Limiting _________ and _________ use

Promote active _____ to _____ switch therapy

Answer 15

overuse ; inappropriate use

IV to PO

Question 16

Stewardship tactics
2 core proactive evidence –based strategies

•___________ ___________ and ___________

•___spective ________ with _______ and __________

•Supplemental strategies

Answer 16

Formulary restriction

pre-authorisation

Prospective audit

intervention ; feedback

Question 17

Formulary Restriction and Pre- Authorization
The strategy involves
•limiting the use of antimicrobials to ________ __________.
•An antimicrobial ________ creates ____________ pertaining to the approved use of agents
•Designated personnel are made available for the approval process.

The strategy leads to
•direct control over antimicrobial use at an institution
•Also, ___________ for prescribers

Answer 17

approved indications.

committee ; guidelines

education

Question 18

Prospective Audit With Intervention and Feedback Involves a _______ review of targeted agents for appropriateness.

Follow-up intervention may involve contacting the prescriber to _____________________________.

Require an antimicrobial ________ to develop guidelines for appropriate use of targeted agents,

Personnel - Needed to perform the __________ and __________ on a __________ basis.

Answer 18

daily

recommend alternative agents.

committee ; reviews

follow-up communication

daily

Question 19

Strategy in LUTH
The chosen intervention is _________________ with ____________ and ____________

Personnel - Needed to perform the reviews and follow-up communication on a daily basis.

What does it take for the personnel to perform the reviews?

Gather data regarding this: YOUR GOAL

Answer 19

Prospective audit with intervention and feedback

Question 20

Objectives

Overall
Determine ______________ of antibiotics prescribed and ___________ with hospital policies

Specific
Study the antibiotic _______
Study the antibiotic ________
Study the ______ for the reviews (checklist)
Apply these to patients’ case notes Report findings

Answer 20

appropriateness; compliance

guidelines; policies

tool

Question 21

LUTH Antibiotic policy List and categorise antimicrobials
– general use, reserved, restricted
All departments in the hospital must develop antibiotic guidelines
Every antibiotic prescription must be in accordance with guidelines
All antimicrobial prescriptions must have duration or date of review
Indication for antimicrobial therapy must be written in patients’ case notes
Every prescription must be backed by indicators - microbiology investigations, a biomarker, etc
Parenteral antimicrobial therapy only where patient cannot take orally or where acceptable indications for parenteral route

Answer 21

Yay