This document discusses antimicrobial stewardship programs (AMSP). It defines AMSP according to various organizations and outlines its goals and importance in preventing antimicrobial resistance. The document discusses implementing AMSP, including establishing a multidisciplinary antimicrobial stewardship team and committee, developing an antimicrobial policy, and employing interventions like formulary restriction and automatic stop orders. It also covers monitoring AMSP through surveillance of antimicrobial consumption and resistance patterns.
The document discusses antimicrobial stewardship and the need to curb antibiotic overuse and misuse. It notes that nearly half of hospitalized patients receive antimicrobial agents. While antibiotics have been life-saving, there has been too much use for trivial infections and without understanding principles of therapy. This has contributed to the rise of antibiotic resistance, which the CDC calls a "major public health crisis." The document outlines strategies for antimicrobial stewardship programs, including prospective audits, formulary restrictions, education, guidelines, and streamlining therapy based on culture results. The goal is to optimize outcomes while minimizing resistance by ensuring appropriate antibiotic use.
This document discusses antimicrobial resistance and strategies to address it. It notes that antibiotic overuse has led to many resistant infections worldwide. To combat this, the WHO advocates a coordinated, multi-sector response including prudent antibiotic use, infection control, surveillance, and new drug development. Key strategies to reduce resistant infections in healthcare facilities include antibiotic stewardship programs, hand hygiene, isolation precautions, and developing treatment guidelines based on local resistance patterns.
This document outlines an Antibiotic Stewardship Program (ASP) and provides guidance on its implementation. It discusses the rising threat of antimicrobial resistance globally and in India. The goals of an ASP are to combat resistance, improve patient outcomes, safety and reduce costs. Key elements include establishing a multidisciplinary team, conducting surveillance of antibiotic use and resistance patterns, implementing guidelines and formulary restrictions, and optimizing antibiotic use through interventions like automatic substitution and de-escalation of therapy. Barriers to ASP include lack of infrastructure, data and clinician knowledge. Laboratories play an important role through rapid diagnostics and susceptibility testing to guide appropriate empirical therapy.
The document discusses the importance and components of antibiotic stewardship programs. It notes that antimicrobial resistance is increasing as development of new antibiotics is slowing. An antibiotic stewardship program aims to optimize antibiotic use, prevent resistance, and improve outcomes. Key components include monitoring antibiotic use, providing education to prescribers, and implementing guidelines and interventions to ensure appropriate antibiotic selection, dosage, and duration. The goals are to improve patient safety, reduce costs, and slow the development of drug-resistant bacteria.
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
The document discusses antibiotic misuse and its consequences. It notes that overuse of antibiotics, such as taking them for viral infections, promotes antibiotic resistance. When antibiotics are used inappropriately, like for a cold or flu, they do not cure the infection and can cause harmful side effects. The overuse of antibiotics in livestock is also discussed, and how it may contribute to antibiotic resistance in bacteria. The consequences of antibiotic resistance include more serious and costly illnesses that are more difficult to treat. The document emphasizes reducing unnecessary antibiotic use to help slow the development of antibiotic-resistant bacteria.
Antibiotic resistance occurs when bacteria change in response to antibiotic use, making infections harder to treat. Bacteria, not humans or animals, become resistant. This leads to higher medical costs, prolonged hospital stays, and increased deaths. Antibiotic resistance threatens global health and can affect anyone, of any age, in any country. It occurs naturally but also because of misuse of antibiotics in humans and farm animals. This is making many infections like pneumonia, tuberculosis, and gonorrhea more difficult to treat.
The document discusses antimicrobial stewardship and the need to curb antibiotic overuse and misuse. It notes that nearly half of hospitalized patients receive antimicrobial agents. While antibiotics have been life-saving, there has been too much use for trivial infections and without understanding principles of therapy. This has contributed to the rise of antibiotic resistance, which the CDC calls a "major public health crisis." The document outlines strategies for antimicrobial stewardship programs, including prospective audits, formulary restrictions, education, guidelines, and streamlining therapy based on culture results. The goal is to optimize outcomes while minimizing resistance by ensuring appropriate antibiotic use.
This document discusses antimicrobial resistance and strategies to address it. It notes that antibiotic overuse has led to many resistant infections worldwide. To combat this, the WHO advocates a coordinated, multi-sector response including prudent antibiotic use, infection control, surveillance, and new drug development. Key strategies to reduce resistant infections in healthcare facilities include antibiotic stewardship programs, hand hygiene, isolation precautions, and developing treatment guidelines based on local resistance patterns.
This document outlines an Antibiotic Stewardship Program (ASP) and provides guidance on its implementation. It discusses the rising threat of antimicrobial resistance globally and in India. The goals of an ASP are to combat resistance, improve patient outcomes, safety and reduce costs. Key elements include establishing a multidisciplinary team, conducting surveillance of antibiotic use and resistance patterns, implementing guidelines and formulary restrictions, and optimizing antibiotic use through interventions like automatic substitution and de-escalation of therapy. Barriers to ASP include lack of infrastructure, data and clinician knowledge. Laboratories play an important role through rapid diagnostics and susceptibility testing to guide appropriate empirical therapy.
The document discusses the importance and components of antibiotic stewardship programs. It notes that antimicrobial resistance is increasing as development of new antibiotics is slowing. An antibiotic stewardship program aims to optimize antibiotic use, prevent resistance, and improve outcomes. Key components include monitoring antibiotic use, providing education to prescribers, and implementing guidelines and interventions to ensure appropriate antibiotic selection, dosage, and duration. The goals are to improve patient safety, reduce costs, and slow the development of drug-resistant bacteria.
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
The document discusses antibiotic misuse and its consequences. It notes that overuse of antibiotics, such as taking them for viral infections, promotes antibiotic resistance. When antibiotics are used inappropriately, like for a cold or flu, they do not cure the infection and can cause harmful side effects. The overuse of antibiotics in livestock is also discussed, and how it may contribute to antibiotic resistance in bacteria. The consequences of antibiotic resistance include more serious and costly illnesses that are more difficult to treat. The document emphasizes reducing unnecessary antibiotic use to help slow the development of antibiotic-resistant bacteria.
Antibiotic resistance occurs when bacteria change in response to antibiotic use, making infections harder to treat. Bacteria, not humans or animals, become resistant. This leads to higher medical costs, prolonged hospital stays, and increased deaths. Antibiotic resistance threatens global health and can affect anyone, of any age, in any country. It occurs naturally but also because of misuse of antibiotics in humans and farm animals. This is making many infections like pneumonia, tuberculosis, and gonorrhea more difficult to treat.
The document outlines an antibiotic policy with the aims of creating awareness about appropriate antibiotic use and reducing healthcare-associated infections. It discusses the growing threat of antibiotic resistance and the need for institutions to establish their own antibiotic resistance data and guidelines for rational antibiotic use. The policy stresses the importance of staff education, adherence to infection control protocols, optimizing antibiotic treatment durations, and monitoring antibiotic resistance to curb rising resistance rates.
1) Principles of Antibiotic Therapy discusses the definition, selection, properties, and complications of antibiotic use. Antibiotics work by interfering with intracellular bacterial processes and their effects depend on factors like dosage concentration and timing.
2) Different classes of antibiotics like beta-lactams, glycopeptides, and macrolides act on various bacterial targets including the cell wall, protein synthesis, and cell membrane. Each antibiotic has a distinct spectrum of activity and side effect profile.
3) Proper use of antibiotics requires considering the infecting organism, resistance patterns, and patient factors to maximize efficacy and minimize harm like antibiotic resistance or toxicity. Combination therapy and alternative drugs exist for resistant infections.
The document summarizes a presentation on antimicrobial drug resistance given by Dr. Manas Kr. Nath. It discusses the objectives of the presentation, which were to introduce antimicrobial drug resistance, define it, discuss its timeline and factors, mechanisms of resistance, control strategies, and conclusions. The presentation covered intrinsic and acquired resistance, genetic and biochemical mechanisms of resistance such as mutations, plasmids, conjugation, transduction, transformation, transposons, integrons, and production of antibiotic inactivating enzymes. It emphasized that antimicrobial resistance is a major global health concern.
This document discusses antibiotic resistance, including the discovery of penicillin, sources and classifications of antibiotics, and how antibiotic resistance develops. It notes that antibiotic resistance was first observed in military hospitals where antibiotics were widely used. Bacteria can develop resistance through genetic mutations and plasmids, decreasing drug concentration through efflux pumps, or producing drug-inactivating enzymes. The overuse and misuse of antibiotics contributes to the spread of resistant infections, which can be difficult or impossible to treat.
The document outlines an antimicrobial stewardship program that aims to optimize antibiotic use through a multidisciplinary team approach. It discusses how pharmacists monitor antibiotic use daily for appropriateness, look for opportunities to convert IV antibiotics to oral ones when possible, review culture data to de-escalate broad spectrum antibiotics, and perform therapeutic drug monitoring. It also describes how the infection control team tracks emerging resistance, analyzes healthcare-associated infections, and incorporates stewardship into broader infection prevention efforts through annual antibiogram reviews and periodic evaluations of antibiotic use. The overall goal is to improve patient outcomes while containing costs and slowing the development of resistance.
Penicillin and other beta-lactam antibiotics work by inhibiting the final step of bacterial cell wall synthesis (transpeptidation or cross-linkage). This exposes the cell membrane which is structurally less stable. They inactivate bacterial enzymes called penicillin-binding proteins that are involved in cell wall synthesis and maintenance of cell morphology. Cephalosporins have a similar mechanism of action, inhibiting cell wall synthesis and activating autolysin enzymes. Carbapenems have broad-spectrum activity and are resistant to beta-lactamases. Vancomycin inhibits cell wall synthesis by binding to the D-alanyl-D-alanine portion of peptidoglycan precursors.
The document discusses antibiotic stewardship and strategies to combat antibiotic resistance. It outlines how inappropriate antibiotic use has led to increased antibiotic resistant organisms and how antimicrobial stewardship aims to optimize antibiotic use and minimize unintended consequences. The document provides numerous examples of antibiotic stewardship strategies including obtaining cultures before prescribing antibiotics, using local antibiotic resistance data to guide treatment, reviewing culture results to modify prescriptions, restricting broad-spectrum antibiotics, and monitoring treatment response and duration. It stresses the importance of education, guidelines, surveillance, and metrics to evaluate antibiotic stewardship programs.
This document discusses antibiotic resistance. It begins by introducing antibiotics and their mechanisms of action in treating bacterial infections. It then defines antibiotic resistance as occurring when bacteria change in response to antibiotics, making the antibiotics ineffective. The document outlines two ways bacteria become resistant: genetic mutation or acquiring resistance from other bacteria. It provides examples of "superbugs" like MRSA, VRSA, and VRE that have developed resistance. Finally, it notes that minimizing unnecessary antibiotic use can help reduce the spread of resistance.
This document outlines the need for an antibiotic policy and various strategies to address the growing issue of antimicrobial resistance. Key points include:
1. Antibiotic overuse and misuse, such as adding antibiotics to animal feed and multiple inconsistent prescriptions, have contributed to the emergence of "superbugs" resistant to most antibiotics.
2. An antibiotic policy aims to reduce resistance by promoting best practices, restricting unnecessary antibiotic use, and improving education.
3. Strategies proposed include banning over-the-counter antibiotic sales, educating medical staff, strengthening surveillance of resistant bacteria, and monitoring antibiotics of last resort like colistin.
4. Proper documentation of antibiotic resistance patterns using software like
The document discusses antibiotic stewardship programs (ASPs) and the growing problem of antibiotic resistance. It notes that approximately 50% of antibiotic use is inappropriate, contributing to the development of resistance. ASPs aim to optimize antibiotic use and prevent resistance through coordinated interventions. The document emphasizes the importance of local antibiotic resistance data to inform treatment decisions and highlights challenges around compliance with standards for tracking resistance patterns. It also explores opportunities to leverage electronic health records and decision support software to enhance ASPs.
The document provides an overview of antibiotic resistance, including definitions of antibiotics and antibiotic resistance. It discusses mechanisms of antibiotic resistance such as enzyme modification, altered target sites, efflux pumps, and decreased membrane permeability. Causes of resistance include overuse and misuse of antibiotics in humans, agriculture, and health care settings. Management of resistance involves prudent antibiotic use, infection control, developing new antibiotics, and global cooperation. National action plans aim to combat resistance through improved awareness, surveillance, optimal antibiotic use, and investments in research.
This document discusses antimicrobial stewardship and the role of microbiologists in stewardship programs. It notes that excessive antimicrobial use has led to increased resistance, and that 30-50% of antimicrobial use may be unnecessary. Antimicrobial stewardship programs aim to optimize antimicrobial use through education, formulary restrictions, prior approval programs, and prospective audits. The document emphasizes that microbiologists should be core members of stewardship teams by providing surveillance data on local resistance trends, patient-specific information to guide therapy, and ensuring high quality specimen collection and reporting to support optimal antibiotic use.
Antibiotic resistance,introduction, cause, mechanism and solution of Antibiot...Dr. Sharad Chand
A illustrative representation of the antibiotic resistance, its introduction, cause, mechanism, examples and possible solutions of the antibiotic resistance. with pictorial illustrations for better understanding.
This document discusses antimicrobial resistance and antibiotic use. It defines antibiotics and their classifications including site of action, mode of action, and spectrum of activity. It discusses the misuse of antibiotics and factors that can lead to drug resistance. Antimicrobial resistance has reached crisis levels and is linked to overuse of antibiotics. The document recommends educating healthcare professionals, hospitals, pharmacists, students and patients about appropriate antibiotic usage to curb rising antimicrobial resistance.
This document discusses the pharmacodynamics of antibiotics. It explains that the time course of drug concentration at the infection site and potential toxic effects are closely related to antibiotic effect. Pharmacodynamic factors that determine antibiotic activity include pathogen susceptibility, whether the drug is bactericidal or bacteriostatic, drug synergism/antagonism, and post-antibiotic effects. Pharmacodynamic information is important for optimizing antibiotic dosage regimens. The document also discusses concepts like minimum inhibitory concentration, minimum bactericidal concentration, and time-dependent versus concentration-dependent antibiotic killing.
This document discusses herbal antimicrobials as an alternative to conventional antibiotics to address antimicrobial resistance (AMR). It provides information on the scope of AMR globally, including an estimated 1.27 million deaths directly attributable to resistance in 2019. The document then summarizes research on the antimicrobial properties of various herbs and oils, including carvacrol, ajowan oil, thyme oil, and cinnamaldehyde. It presents data on the susceptibility of different bacterial strains to these herbal antimicrobials. The document concludes by acknowledging limitations to the therapeutic use of herbal antimicrobials, such as a lack of quality control and defined therapeutic doses, but also their potential to be effective antimicrobial treatments.
The document discusses hospital antibiograms, which are periodic summaries of antimicrobial susceptibilities of bacterial isolates in a hospital. They are useful for clinicians to assess local susceptibility rates and monitor resistance trends over time. The document covers various topics related to antibiograms including how they are tested, interpreted, and documented. It emphasizes the importance of generating antibiograms using standardized methods and interpreting them carefully based on multiple factors.
4. Evolving Roles of Pharmacists in AMS by Dr. Mediadora Saniel.pdfMarkAnthonyEllana1
This document outlines the evolving roles of pharmacists in antimicrobial stewardship programs in the Philippines. It discusses the rationale for antimicrobial stewardship due to issues like antimicrobial resistance. It describes current antimicrobial stewardship programs in the country, which involve pharmacists in coordination and implementation. The document proposes expanding the role of pharmacists to include more direct patient care activities like performing point-of-care interventions to optimize antimicrobial therapy. Overall, the document argues that pharmacists can and should play a critical role in antimicrobial stewardship efforts in the Philippines.
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
The document outlines an antibiotic policy with the aims of creating awareness about appropriate antibiotic use and reducing healthcare-associated infections. It discusses the growing threat of antibiotic resistance and the need for institutions to establish their own antibiotic resistance data and guidelines for rational antibiotic use. The policy stresses the importance of staff education, adherence to infection control protocols, optimizing antibiotic treatment durations, and monitoring antibiotic resistance to curb rising resistance rates.
1) Principles of Antibiotic Therapy discusses the definition, selection, properties, and complications of antibiotic use. Antibiotics work by interfering with intracellular bacterial processes and their effects depend on factors like dosage concentration and timing.
2) Different classes of antibiotics like beta-lactams, glycopeptides, and macrolides act on various bacterial targets including the cell wall, protein synthesis, and cell membrane. Each antibiotic has a distinct spectrum of activity and side effect profile.
3) Proper use of antibiotics requires considering the infecting organism, resistance patterns, and patient factors to maximize efficacy and minimize harm like antibiotic resistance or toxicity. Combination therapy and alternative drugs exist for resistant infections.
The document summarizes a presentation on antimicrobial drug resistance given by Dr. Manas Kr. Nath. It discusses the objectives of the presentation, which were to introduce antimicrobial drug resistance, define it, discuss its timeline and factors, mechanisms of resistance, control strategies, and conclusions. The presentation covered intrinsic and acquired resistance, genetic and biochemical mechanisms of resistance such as mutations, plasmids, conjugation, transduction, transformation, transposons, integrons, and production of antibiotic inactivating enzymes. It emphasized that antimicrobial resistance is a major global health concern.
This document discusses antibiotic resistance, including the discovery of penicillin, sources and classifications of antibiotics, and how antibiotic resistance develops. It notes that antibiotic resistance was first observed in military hospitals where antibiotics were widely used. Bacteria can develop resistance through genetic mutations and plasmids, decreasing drug concentration through efflux pumps, or producing drug-inactivating enzymes. The overuse and misuse of antibiotics contributes to the spread of resistant infections, which can be difficult or impossible to treat.
The document outlines an antimicrobial stewardship program that aims to optimize antibiotic use through a multidisciplinary team approach. It discusses how pharmacists monitor antibiotic use daily for appropriateness, look for opportunities to convert IV antibiotics to oral ones when possible, review culture data to de-escalate broad spectrum antibiotics, and perform therapeutic drug monitoring. It also describes how the infection control team tracks emerging resistance, analyzes healthcare-associated infections, and incorporates stewardship into broader infection prevention efforts through annual antibiogram reviews and periodic evaluations of antibiotic use. The overall goal is to improve patient outcomes while containing costs and slowing the development of resistance.
Penicillin and other beta-lactam antibiotics work by inhibiting the final step of bacterial cell wall synthesis (transpeptidation or cross-linkage). This exposes the cell membrane which is structurally less stable. They inactivate bacterial enzymes called penicillin-binding proteins that are involved in cell wall synthesis and maintenance of cell morphology. Cephalosporins have a similar mechanism of action, inhibiting cell wall synthesis and activating autolysin enzymes. Carbapenems have broad-spectrum activity and are resistant to beta-lactamases. Vancomycin inhibits cell wall synthesis by binding to the D-alanyl-D-alanine portion of peptidoglycan precursors.
The document discusses antibiotic stewardship and strategies to combat antibiotic resistance. It outlines how inappropriate antibiotic use has led to increased antibiotic resistant organisms and how antimicrobial stewardship aims to optimize antibiotic use and minimize unintended consequences. The document provides numerous examples of antibiotic stewardship strategies including obtaining cultures before prescribing antibiotics, using local antibiotic resistance data to guide treatment, reviewing culture results to modify prescriptions, restricting broad-spectrum antibiotics, and monitoring treatment response and duration. It stresses the importance of education, guidelines, surveillance, and metrics to evaluate antibiotic stewardship programs.
This document discusses antibiotic resistance. It begins by introducing antibiotics and their mechanisms of action in treating bacterial infections. It then defines antibiotic resistance as occurring when bacteria change in response to antibiotics, making the antibiotics ineffective. The document outlines two ways bacteria become resistant: genetic mutation or acquiring resistance from other bacteria. It provides examples of "superbugs" like MRSA, VRSA, and VRE that have developed resistance. Finally, it notes that minimizing unnecessary antibiotic use can help reduce the spread of resistance.
This document outlines the need for an antibiotic policy and various strategies to address the growing issue of antimicrobial resistance. Key points include:
1. Antibiotic overuse and misuse, such as adding antibiotics to animal feed and multiple inconsistent prescriptions, have contributed to the emergence of "superbugs" resistant to most antibiotics.
2. An antibiotic policy aims to reduce resistance by promoting best practices, restricting unnecessary antibiotic use, and improving education.
3. Strategies proposed include banning over-the-counter antibiotic sales, educating medical staff, strengthening surveillance of resistant bacteria, and monitoring antibiotics of last resort like colistin.
4. Proper documentation of antibiotic resistance patterns using software like
The document discusses antibiotic stewardship programs (ASPs) and the growing problem of antibiotic resistance. It notes that approximately 50% of antibiotic use is inappropriate, contributing to the development of resistance. ASPs aim to optimize antibiotic use and prevent resistance through coordinated interventions. The document emphasizes the importance of local antibiotic resistance data to inform treatment decisions and highlights challenges around compliance with standards for tracking resistance patterns. It also explores opportunities to leverage electronic health records and decision support software to enhance ASPs.
The document provides an overview of antibiotic resistance, including definitions of antibiotics and antibiotic resistance. It discusses mechanisms of antibiotic resistance such as enzyme modification, altered target sites, efflux pumps, and decreased membrane permeability. Causes of resistance include overuse and misuse of antibiotics in humans, agriculture, and health care settings. Management of resistance involves prudent antibiotic use, infection control, developing new antibiotics, and global cooperation. National action plans aim to combat resistance through improved awareness, surveillance, optimal antibiotic use, and investments in research.
This document discusses antimicrobial stewardship and the role of microbiologists in stewardship programs. It notes that excessive antimicrobial use has led to increased resistance, and that 30-50% of antimicrobial use may be unnecessary. Antimicrobial stewardship programs aim to optimize antimicrobial use through education, formulary restrictions, prior approval programs, and prospective audits. The document emphasizes that microbiologists should be core members of stewardship teams by providing surveillance data on local resistance trends, patient-specific information to guide therapy, and ensuring high quality specimen collection and reporting to support optimal antibiotic use.
Antibiotic resistance,introduction, cause, mechanism and solution of Antibiot...Dr. Sharad Chand
A illustrative representation of the antibiotic resistance, its introduction, cause, mechanism, examples and possible solutions of the antibiotic resistance. with pictorial illustrations for better understanding.
This document discusses antimicrobial resistance and antibiotic use. It defines antibiotics and their classifications including site of action, mode of action, and spectrum of activity. It discusses the misuse of antibiotics and factors that can lead to drug resistance. Antimicrobial resistance has reached crisis levels and is linked to overuse of antibiotics. The document recommends educating healthcare professionals, hospitals, pharmacists, students and patients about appropriate antibiotic usage to curb rising antimicrobial resistance.
This document discusses the pharmacodynamics of antibiotics. It explains that the time course of drug concentration at the infection site and potential toxic effects are closely related to antibiotic effect. Pharmacodynamic factors that determine antibiotic activity include pathogen susceptibility, whether the drug is bactericidal or bacteriostatic, drug synergism/antagonism, and post-antibiotic effects. Pharmacodynamic information is important for optimizing antibiotic dosage regimens. The document also discusses concepts like minimum inhibitory concentration, minimum bactericidal concentration, and time-dependent versus concentration-dependent antibiotic killing.
This document discusses herbal antimicrobials as an alternative to conventional antibiotics to address antimicrobial resistance (AMR). It provides information on the scope of AMR globally, including an estimated 1.27 million deaths directly attributable to resistance in 2019. The document then summarizes research on the antimicrobial properties of various herbs and oils, including carvacrol, ajowan oil, thyme oil, and cinnamaldehyde. It presents data on the susceptibility of different bacterial strains to these herbal antimicrobials. The document concludes by acknowledging limitations to the therapeutic use of herbal antimicrobials, such as a lack of quality control and defined therapeutic doses, but also their potential to be effective antimicrobial treatments.
The document discusses hospital antibiograms, which are periodic summaries of antimicrobial susceptibilities of bacterial isolates in a hospital. They are useful for clinicians to assess local susceptibility rates and monitor resistance trends over time. The document covers various topics related to antibiograms including how they are tested, interpreted, and documented. It emphasizes the importance of generating antibiograms using standardized methods and interpreting them carefully based on multiple factors.
4. Evolving Roles of Pharmacists in AMS by Dr. Mediadora Saniel.pdfMarkAnthonyEllana1
This document outlines the evolving roles of pharmacists in antimicrobial stewardship programs in the Philippines. It discusses the rationale for antimicrobial stewardship due to issues like antimicrobial resistance. It describes current antimicrobial stewardship programs in the country, which involve pharmacists in coordination and implementation. The document proposes expanding the role of pharmacists to include more direct patient care activities like performing point-of-care interventions to optimize antimicrobial therapy. Overall, the document argues that pharmacists can and should play a critical role in antimicrobial stewardship efforts in the Philippines.
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
This document discusses antimicrobial stewardship (AMS), which aims to optimize antibiotic use and limit resistance. The goals of AMS are to improve patient outcomes, limit emergence of resistance, and reduce costs. An AMS team should include infectious disease physicians, pharmacists, nurses, microbiologists, and administrators. Key strategies include prospective auditing, formulary restrictions, education, guidelines, streamlining therapy based on cultures, dose optimization, and intravenous to oral conversion when possible. Barriers to effective AMS include lack of resources, unclear protocols, and poor communication. Strong leadership and a multidisciplinary team culture are important for AMS success.
The National Antibiotic Guidelines provide concise treatment recommendations for common infections to promote rational antibiotic use in the Philippines. A committee was formed to develop the guidelines which consolidate existing evidence and expert consensus. The guidelines cover treatment of various adult and pediatric infections across different clinical settings and healthcare levels. Their goal is to improve patient outcomes while reducing antimicrobial resistance and healthcare costs.
The document outlines World Health Organization (WHO) guidelines for developing an antibiotic policy and strategies to promote rational antibiotic use in hospitals. It discusses establishing an antimicrobial resistance (AMR) surveillance system, developing standard treatment guidelines based on a cumulative antibiogram, and forming an antimicrobial management team. The document emphasizes optimizing antibiotic treatment duration and type based on culture/sensitivity results and instituting antimicrobial stewardship programs.
Antimicrobial resistance has emerged as a major public health problem worldwide. Infections caused by resistant microbes are difficult to treat, prolonging illness and increasing mortality risk. This also leads to longer periods of infectivity, exposing more people to resistant strains. When microbes become resistant to first-line drugs, second-line drugs may be too expensive for many to access treatment. Multidrug-resistant infections are virtually untreatable, creating a "post-antibiotic era." Healthcare facilities must establish antibiotic management teams and policies to minimize antimicrobial resistance and preserve antibiotic effectiveness. Policies should be evidence-based, regularly reviewed, and aligned with national policies while accounting for local resistance patterns.
Antibiotic stewardship explained in one presentation, which can be helpful to the medical field beginners and students as well as thorough information can be obtained regarding the subject matter.
Objectives:
1. To understand the purpose of implementing an antimicrobial stewardship program (ASP)
2.To recall the core elements of hospital and outpatient antibiotic stewardship programs as defined by the CDC
3. To recognize key interventions that an antimicrobial stewardship program can implement in both the hospital and community settings
The document discusses antibiotic stewardship programs in hospitals. It describes the core elements of such programs, including establishing guidelines and protocols for optimal antibiotic use, educating staff, and monitoring antibiotic use and resistance. It also outlines strategies hospitals use like prospective audits, formulary restrictions, education, and developing order sets. The challenges of implementing and sustaining antibiotic stewardship programs are also examined.
ANTIBIOTIC STEWARDSHIP MEANS :USE OF THE RIGHT PATIENT,AT THE RIGHT TIME WITH...Dr. Nagendra Kumar
use of the right antimicrobial, for right patient, at the right time, with right dose, right route, and frequency, causing the least harm to the patients and future patients as per CDC.
Refers to the coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regime, dose, duration of therapy, and route of administration[IDSA]
Antibiotic policy and trends in antibiotic policy,
References
Infection control: Basic concepts and practices, 2nd edn.
www.cdc.org
Antibiotics guide: choices for common infections
Chennai Declaration
Antibiotic; introduction & stewardship program in childrenAzad Haleem
This document discusses antibiotics, including their definitions, types, and classifications. It describes how antibiotics can be classified based on their spectrum of activity (broad or narrow), site of action, and type of action (bacteriostatic or bactericidal). The document also addresses antibiotic resistance, factors that contribute to resistance, and the importance of antibiotic stewardship programs in optimizing antibiotic use and limiting resistance.
Strategies to prevent surgical site infections should include attention to infection control, surgical technique, hospital environment, sterilization processes, and patient risk factors. Antibiotic prophylaxis should be administered before procedures with high infection risks or foreign material implantation, using antibiotics effective against likely pathogens. Antibiotic therapy should be started empirically for suspected surgical infections until culture results are available, choosing antibiotics based on local resistance patterns and patient history. Antibiotic treatment duration should be shortened once infection signs resolve to help reduce antimicrobial resistance.
For decades microbes, in particular bacteria, have become increasingly resistant to various antimicrobials.
The World Health Assembly’s endorsement of the Global Action Plan on Antimicrobial Resistance (AMR) in May 2015, and the Political Declaration of the High-Level Meeting of the General Assembly on AMR in September 2017, both recognize AMR as a global threat to public health.
These policy initiatives acknowledge overuse and misuse of antimicrobials as a main driver for development of resistance, as well as a need to optimize the use of antimicrobials.
The Global Action Plan on AMR sets out five strategic objectives as a blueprint for countries in developing national action plans (NAPs) on AMR:
Objective 1: Improve awareness and understanding of AMR through effective communication, education and training.
Objective 2: Strengthen the knowledge and evidence base through surveillance and research.
Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.
Objective 4: Optimize the use of antimicrobial medicines in human and animal health.
Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Antimicrobial stewardship programmes optimize the use of antimicrobials, improve patient outcomes, reduce AMR and health-care-associated infections, and save health-care costs amongst others.
Today, AMS is one of three “pillars” of an integrated approach to health systems strengthening. The other two are infection prevention and control (IPC) and medicine and patient safety.
Linking all three pillars to other key components of infection management and health systems strengthening, such as AMR surveillance and adequate supply of quality assured medicines, promotes equitable and quality health care towards the goal of achieving universal health coverage
CDC has defined “Antimicrobial stewardship” as-
The right antibiotic
for the right patient,
at the right time,
with the right dose, and
the right route, causing
the least harm to the patient and future patients
Why AMSP is needed?
Antimicrobial Resistance (AMR)
Misuse and Over-use of Antimicrobials
Widespread Use of Antimicrobials in Other Sectors
Poor Antimicrobial Research
IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAM
Administrative Support (Leadership)
Formulating AMS Team
Infrastructure Support
Framing Antimicrobial Policy
Implementing AMS strategies
Education and Training
Should be publicly committed to the program.
Provide necessary funding and infrastructure support.
Multidisciplinary committee - responsible for framing, implementing and monitoring the compliance to antimicrobial policy of the hospital.
Led by the antimicrobial steward - infectious disease physician or infection control officer or clinical microbiologist.
Other members of AMS team - stewardship nurses
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
This document discusses rational antibiotic use and antibiotic resistance. It defines rational antibiotic use as patients receiving appropriate medications for their clinical needs in adequate doses and durations at the lowest cost. Antibiotic overuse and misuse can lead to antibiotic resistance where infections become difficult or impossible to treat. The emergence of multidrug-resistant bacteria is a major public health threat. Hospitals should establish antibiotic policies and guidelines to promote appropriate antibiotic prescribing and prevent the spread of resistance.
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2. SYNOPSIS
• INTRODUCTION OF AMSP
• IMPLEMENTATION OF AMSP
• MONITORING OF AMSP
• CURRENT SCENARIO OF AMR AND ROLE OF AMR
SURVEILLANCE
• AMS IN SPECIAL SITUATIONS
• ONE HEALTH APPROACH
• ANTIBIOGRAM
• ANTIFUNGAL STEWARDSHIP
• ANTIVIRAL STEWARDSHIP
3. ANTIMICROBIAL STEWARDSHIP
It is an inter-professional efforts across the
continuum of care that involves
• Timely and optimal selection, dose and
duration of an antimicrobial
• For the best clinical outcome for treatment or
prevention of infection
• With minimal toxicity to the patient
• And minimum impact on resistance and other
ecological adverse events
4. WHO DEFINITION OF AMS
Stewardship – Careful and responsible management
of something entrusted to one’s care
AMS – Coherent set of actions which promote the
responsible use of antimicrobials at
individual/national/global level
AMS Program – Organization or system wide health
care strategy to promote the appropriate use of
antimicrobials through the implementation of
evidence based interventions
5. CDC DEFINITION OF AMS
The use of the right antimicrobial, for the right
patient at the right time, with the right dose,
route and frequency, causing the least harm to
the patient and future patients
6. IDSA DEFINITION OF AMS
Co-ordinated interventions designed to
improve and measure the appropriate use of
antimicrobials by promoting the selection of
the optimal antimicrobial drug regimen, dose,
duration of therapy and route of
administration
7. EIGHT 8Ds OF AMS
• Diagnosis
• Drug
• Dosage
• Diagnostics
• De-escalation
• Duration
• Debridement/Drainage
• Disease prevention and control measures
8. WHY AMSP IS NEEDED?
• To prevent antimicrobial resistance
• Misuse and overuse of antimicrobial agents
• Use of antimicrobials in other sectors
• Poor antimicrobial research
11. ANTIMICROBIAL PRESCRIPTION
30% RULE
• 30% of hospitalized patients at any given time
receive antimicrobial agents
• 30% of antimicrobials prescribed
inappropriately in the community
• Up to 30% of surgical prophylaxis is
inappropriate
• 30% of hospital pharmacy costs are due to
antimicrobial use
• 10-30% pharmacy costs can be saved by
antimicrobial stewardship programs
12. GOALS OF AMS
• Reduce antimicrobial resistance
• Improve patient outcomes
• Improve patient safety through minimizing
unintended consequences of antimicrobials
• Reduce health care cost towards antimicrobial
drugs without affecting quality
16. AWARE CLASSIFICATION- PURPOSE OF
THIS CLASSIFICATION
• To monitor antimicrobial consumption
• Defining targets and monitoring effects of the
antimicrobial stewardship policies
17. GOAL OF AWARE CLASSIFICATION
By the end of 2023, WHO aims country level
target of at-least 60% of total antimicrobial
consumption from Access group & less than
40% from watch and reserve group
18. THREE GROUPS
• Access (87 drugs as per 2021 update) – 21*
• Watch (141 drugs as per 2021 update) – 12*
• Reserve (29 drugs as per 2021 update) – 8*
NOTE: Each group is having one division called
as ESSENTIAL MEDICINES (EML) for empirical
treatment
(* )- WHO EML list
19. ACCESS GROUP
• Includes antimicrobials that have activity
against a wide range of community
encountered susceptible pathogens while also
showing lower resistance potential than
antimicrobials in other group.
21. WATCH GROUP
• Includes antimicrobials that have higher
resistance potential and includes most of the
highest priority agents among the critically
important antimicrobials for human medicine
• Antimicrobials in WATCH group should be
prioritized as key targets for stewardship
programme.
23. RESERVE GROUP
• Includes antimicrobials and agents that should
be reserved for treatment of confirmed or
suspected infections due to MDRO
• Considered as LAST RESORT when every other
alternatives failed.
• These drugs could be protected and
prioritized as key targets of antimicrobial
stewardship programme and monitoring.
25. BARRIERS IN IMPLEMENTATION OF
AMSP
• Clinician knowledge deficit on usage of
antimicrobials and opposition from their side
• Limited access of antimicrobials
• Fear of poor outcome by withholding
antimicrobials
• Lack of communication among health care
workers
• Limited public/patient acceptance of AMSP
• OTC sales of antimicrobial drugs
27. CORE ELEMENTS – WHO CHECK LIST
• NAP (National Action Plan) on AMR states that
AMS is a national priority
• Dedicate funding for national action plan on
AMR
• Technical working group on AMS
• Defined goals, outcomes, timelines and
structures has been developed
• Monitoring and evaluation mechanism for
NAP on AMR
28. CORE ELEMENTS – WHO CHECK LIST
(cont.)
• Integration of AWARE classification of antibiotics
with WHO essential medicines list
• Up to date clinical guidelines includes AMS
principles and integrate with AWARE antibiotics
• Regulations of fixed dose combinations of drugs
• Regulations on prescription only sales of
antibiotics
• Ensure continued availability of quality assured
antibiotics
• Ensure affordability of essential antibiotics
29. CORE ELEMENTS – WHO CHECK LIST
(cont.)
• Public antibiotic awareness campaigns
• Education in schools on basic infection control
principles
• Training on AMS competencies for AMS team
members
• Education and training given to health care
workers
• Incentives to support AMSP implementation
30. CORE ELEMENTS – WHO CHECK LIST
(cont.)
• National surveillance system on antimicrobial
consumption
• National surveillance system on AMR in place
with laboratory capacity
• Diagnostic tests are available and capacity
building are undertaken to optimise
antimicrobial use
32. STEPS OF IMPLEMENTATION OF AMS
PROGRAM IN A HOSPITAL
• Administrative support (Leadership)
• Set up AMS committee and AMS team
• Multi disciplinary support
• Framing antimicrobial policy
• Implementing stewardship strategies
• Education and training
34. AMS COMMITTEE MEMBERS
• Health care facility leadership (Medical
director/Medical superintendent) – CHAIR
PERSON
• AMS team members
• HODs of various departments including
microbiology and pharmacology in particular
• In-charges of intensive care units
• Nursing superintendent
• AMS Steward – Member secretary
35. AMS COMMITTEE (cont.)
• Meeting not less than once in three months
• At-least a week prior notice via mail or letter to
all departments
• On that particular day reminder is must
• Presentation on AMR current trend in our
hospital
• Review of last meeting
• The minutes of meeting should be documented
36. CORE MEMBERS OF MULTI
DISCIPLINARY AMS TEAM
• Infectious diseases physician (FIRST CHOICE)
• Infection control officer
• Clinical microbiologist
• Internal medicine physician
• Clinical pharmacists with infectious disease
training
• AMS nurses with infectious diseases training
• Officer in charge of pharmacy
• Clinical pharmacologist
37. ANTIBIOTIC STEWARD QUALITIES
• He/she is the central driving force behind this
program
• Having skills like communication, teamwork
• Ability to influence others
• Commands the respect of peers
• Inspires trust with all stakeholders
• Motivates the team
• Possesses the long range perspective
• Creates and recognises opportunity
39. ID PHYSICIAN
• First choice to lead AMS team
DISADVANTAGES
• Paucity of ID physicians in India
• Lack of vacant posts in government sectors
• Lack of time allotment to do stewardship work
41. INFECTION CONTROL OFFICER
• Mostly ICO will be clinical microbiologist since
they are expert in infection control
stewardship
DISADVANTAGES
• Insufficient clinical expertise
• Limited knowledge of treatment guidelines
and antimicrobial drugs
• But at the same time if ICO is from non-
microbiological background then diagnostic
stewardship will be big challenge
42. INTERNAL MEDICINE PHYSICIAN
• Much better than ID physician
• Having through clinical knowledge
• More familiar with clinical work practice and
ward rounds
DISADVANTAGES:
• Limited and suboptimal knowledge on
diagnostic and infection control stewardship
43. CLINICAL PHARMACIST
• Well fit for western countries
ROLE:
• Prescription audit
• Separate rounds in ward and then rounds with
AMS steward to save the time for AMS steward
• Pharmacokinetic monitoring
• Drug allergy monitoring
• Discharge advisory for the patients
• Educating the patients and other health care
workers
44. HAND SHAKE STEWARDSHIP
In 2019, CDC introduces
hand shake stewardship
with pharmacists and
physicians for effective
implementation of
AMSP in hospital
45. LIMITATIONS OF CLINICAL
PHARMACIST
• Lack infection control and microbiological
expertise
• Lacks clinical knowledge
• Paucity of ID trained clinical pharmacists in
India
46. STEWARDSHIP NURSES
• Advantages are availability of nurses is high,
Sufficient IPC knowledge, Familiar with
hospital work flow
ROLE:
• Ensure collection of proper samples
• Keeping track on laboratory reports
• To keep a check on administrative errors
(Dose, route of administration)
• Educating the patient
• AMS audit
47. OFFICE INCHARGE OF PHARMACY
• Member should be from pharmacology
department (Faculty)
• List of antimicrobial agents available
• Quality assurance
• Formulary restriction
• Pre authorization for restricted drugs
• Automatic stop order
48. CLINICAL PHARMACOLOGIST
• Contributing formulation of antimicrobial
policy
• Therapeutic drug monitoring
• Training of pharmacists
• Look for drug-drug interactions, adverse
effects and pharmacovigilance
49. MULTI DISCIPILINARY SUPPORT
• Support from microbiology laboratory
• Support from pharmacology laboratory
• Support from HICP unit
• Link between IPC and AMS
• Support from IT wing
• Role of individual stake holders in AMSP
51. “GUIDELINE NOT MINDLINE”
• Physicians should strictly adhere to the
guidelines for rationalizing the antibiotic use
rather following mind lines (View of peer or
senior physicians or local practice or pressure
from medical representatives)
52. FRAMING ANTIMICROBIAL POLICY
It includes
• Title page
• Goal of AMSP
• List of available antimicrobials
• General guidelines
• Antibiogram data of last year
• Treatment regimen for system wise
All guidelines based on IDSA, Sanford’s guide, ICMR,
NCDC, Mandell, Doughlas and Bennett’s principles and
Harrison’s Principles of Internal Medicine
53. ROLE OF INFORMATION TECHNOLOGY
IN AMS
• By providing clinical decision support system
(CDSS)
• Recording and facilitating the informational
workflow
• By helping implementation and monitoring of
AMS interventions
54. HEALTH CARE IT SERVICES
• Hospital information system (HIS)
• Laboratory information system (LIS)
• Electronic Medical record (EMR)
• Electronic Health record (EHR)
• Ayushman Bharat Digital Mission – ABHA
number
• Personal Health records (PHR)
55. BENEFITS OF LIS
• Data entry
• Tracing of reports
• No risk of losing data
• Statistics
• Online access to reports
• Critical alerts
• Bidirectional communication between
laboratory and wards
56. ABHA NUMBER AND IT’S BENEFITS
The citizens need to create an Ayushman Bharat
Health Account (ABHA) number by linking to
unique identifier such as Aadhar card
• Unique and trustable identity
• Unified benefits
• Hassle free access
• Easy PHR sign up
57. CDSS (COMPUTERIZED DECISION
SUPPORT SYSTEMS)
• Defined as computer applications designed to
aid clinicians in making diagnostic and
therapeutic decisions in patient care and
thereby improving antimicrobial use
58. CDSS AT PHYSICIAN LEVEL
RESTRICTIVE APPROACH:
• Physicians can use this platform for usage of
restricted and semi-restricted drugs
PERSUASIVE APPROACH:
• Includes clinical practice, treatment algorithm,
antimicrobial policy, local antibiogram
59. CDSS AT AMS TEAM LEVEL
POST PRESCRIPTION REVIEW:
• Incorporating data from multiple systems such
as microbiology, pharmacy
CONSUMPTION AUDIT:
• To monitor and measure the impact of AMSP
program.
60. TYPES OF ANTIMICROBIAL CDSSs
1. SIMPLE CDSS
2. COMPLEX CDSS
• Electronic guidelines and mobile applications
• Electronic antimicrobial approval systems
• Electronic infection prevention control and
surveillance systems
• EPS and EMM systems (Electronic prescribing
system and Electronic medication management)
• Clinical microbiology decision support systems
• Advanced decision support systems
61. ELECTRONIC GUIDE AND MOBILE
APPLICATIONS
MOBILE BASED APPLICATIONS DEVELOPED BY
Sanford guide online Sanford Guide, USA
John Hopkin Antibiotic guide John Hopkins, medicine, USA
EMRA antibiotic guide Emergency medicines residents
association, USA
Microguide Horizon strategic partners, UK
AIIMS antibiotic policy AIIMS, Delhi
ICMR treatment guidelines for
antimicrobials in common syndromes
ICMR, India
UptoDate Online Provide various information about
infectious diseases
MedScape
62. ELECTRONIC IPC AND SURVEILLANCE
SYSTEMS
• Safety surveillor and Theradoc systems,
Premium Healthcare, North carolina
• MedMined CareFusion, BD, New Jersey
• Sentri7, Wolters Kluwer
• RL solutions RL, Canada
• Ibhar IPC module, JIPMER, India (IPC module,
CMR module, AMS module)
63. INTERVENTION OF AMSP
Front end strategy (Restrictive strategy)
• Intervention applied actively on prescribers
usually before (Sometimes after) prescribing
antimicrobials
Back end strategy (Persuasive/passive strategy)
• Intervention applied passively on clinicians
usually after (Sometimes before) prescribing
antimicrobials
Additional strategy (Resource driven & Guideline
based interventions)
64. FRONT END STRATEGY
• Formulary restriction with preauthorization
• Antibiotic cycling
• Antibiotic mixing
• Automatic stop orders
• Computer physician order entry
• Selective susceptibility reporting from the lab
65. FORMULARY RESTRICTION WITH
PREAUTHORIZATION
Formulary restriction:
• Restricting dispensing of targeted antimicrobials
on the hospital’s formulary (Pharmacy) according
to certain predefined approved criteria
Preauthorization:
• Authorization of the targeted antimicrobials by
the AMS team is needed to procure them from
the hospital formulary
ONLY DISADVANTAGE FOR FRP IS THAT THIS WILL
BE APPLICABLE ONLY WHEN PRESCRIBERS USING
E-PRESCRIPTION.
66. IMPORTANT POINTS ABOUT FRP
• Deciding the antimicrobials based on local AMR
pattern, speciality, suspected clinical diagnosis.
• We can adapt WHO AWARE classification for FRP
strategy (Unrestricted, semi-restricted, restricted
drugs)
• Pre-authorization (Compulsory order form) to be
filled by prescribers
• 24*7 (Round O’ Clock) duties for AMS team to
give approval
68. ANTIBIOTIC CYCLING
• Withdrawal of an antimicrobial agent or
antimicrobial class from general use (Within a
ward or institution) for a designated period of
time and it’s substitution with antimicrobial
agent from different class having a
comparable spectrum of activity, but for which
organism may have different resistance
mechanisms.
70. AUTOMATIC STOP ORDERS
• To encourage the prescribers to routinely
review the antimicrobial prescriptions for their
appropriateness
• Usually performed by AMS team and
pharmacy
71. ANTIMICROBIAL SUPPRESSION
• Withholding (Not releasing) the antimicrobial
susceptibility test (AST) results of certain
antimicrobial agents from the final patient
report. (NOT IN ROUTINE ANTIBIOGRAM)
• Purpose: To encourage appropriate use of
antimicrobial agents.
• Antimicrobial suppression will be done by
THREE METHODS.
72. THREE METHODS OF ANTIMICROBIAL
SUPPRESSION
• Selective reporting
• Cascade reporting
• Testing limitation
73. SELECTIVE REPORTING
Reporting results for specific antimicrobial
agents while suppressing others based on
some criteria
• Organism identification
• Mechanism of resistance
• Body site
• Clinical setting
• Patient demographics
• Aberrant results
• Unavailability of clinical breakpoints
74. ORGANISM IDENTIFICATION
CLINICALLY INEFFECTIVE CLINICALLY NOT REPORTED
Drugs may display susceptible
results in in vitro but clinically
ineffective.
Example:
1st or 2nd generation
cephalosporins and
aminoglycosides for salmonella
infections
Drugs which are effective
against organism but no break
points available. So not
reported.
Example:
Cefepime, Piperacillin
tazobactam, meropenem,
imipenem, ertapenem effective
against salmonella, but not
reported since no breakpoints
given by CLSI
75. MECHANISM OF RESISTANCE
• No need to modify the AST reports even if
any organism is found to be ESBL / AmpC
producing.
76. BODY SITE
No..ssssss in AST report
Respiratory specimen – Daptomycin
CSF – 1st,2nd generation cephalosporins,
erta/doro/imipenem, clindamycin, tetracycline,
macrolides, quinolones, aminoglycosies
Urine specimen – Chloramphenicol, macrolides,
clindamycin
Non urine specimens – Ciprofloxacin, levofloxacin,
nitrofurantoin, norfloxacin, nalidixic acid
78. PATIENT DEMOGRAPHICS
• Suppress antibiotics with known adverse
effect.
Example:
Ciprofloxacin, chloramphenicol & tetracycline
supressed from pediatric case reports
79. ABERRANT RESULTS
• First line drugs are susceptible, second line
drugs are resistant.
So, here suppress the second line drug status.
Example:
Ceftriaxone – S
Meropenem - R
80. UNAVAILABILITY OF BREAKPOINT
• Don’t report that particular drug if breakpoint
is not available.
EVEN DON’T ADMIT IT IN ANTIBIOGRAM
POLICY
81. CASCADE REPORTING
• Reporting of AST results involves reporting of
broader spectrum/costlier/second line drugs
only when narrow spectrum/cheaper/first
line drugs are found to be not susceptible
82. THINGS TO BE REMEMBER WHILE
CASCADE REPORTING
• Pharmacy availability of drug
• Local antimicrobial resistance
• Clinical consensus and patient status
• Following standard guidelines like CLSI or
EUCAST
• Cascade reporting not cascade testing
• Inclusion into antibiogram (Except BP not
available)
83. BACK END STRATEGY
• Audit and feedback
• Pathogen directed AMS audit
• Antimicrobial advices driven interventions
• Prescription audit
• Antibiotic time outs/Review/Self revision
• Dosage optimization
• Automatic alerts
• Behaviour change
• Educational intervention
84. AUDIT AND FEEDBACK
• Assessment of prescribed antimicrobial
treatment, subsequently providing feedback
on inappropriate antibiotic prescription to the
clinical team
TYPES:
• Prospective (Real time) audit with feedback
(Preferable)
• Retrospective Audit with feedback
85. PROSPECTIVE VS RETROSPECTIVE
PROSPECTIVE RETROSPECTIVE
Audit is conducted in real time Audit is conducted retrospectively
Feedback is provided in real time, so that
clinicians will ask doubts and get clarified
It doesn’t happen
Feedback on individual patient
prescription provided
Overall feedback on antimicrobial use of
the location is provided
Opportunity to modify individual patient
prescription
No opportunity to modify
Opportunity to educate and training of the
clinical team
No opportunity for that
More time stringent since it’s real time
audit
Greater flexibility in timing to conduct the
audit
86. AUDIT AND FEEDBACK
(Stage wise approach)
• One stage approach – AMS team rounds along
with clinical team
• Two stage approach – Clinical pharmacist ID
trained, Infection control nurse rounds first
and then rounds with clinical team, ID
physician & Clinical microbiologist
87. PATHOGEN DIRECTED AMS AUDIT
(PD AMS AUDIT)
• It is a modification of prospective audit and
feedback in which the audit is conducted
prospectively for the patients with culture
proven infections by
telephonic/Bedside/Written communication
90. PRESCRIPTION AUDIT
• Facility level assessment exercise conducted
periodically, for reviewing the facility’s
prescriptions, of which audit of antibiotic
prescription is one of the main component.
• To do this, e-prescription is the best one
• If prescription is done manually, first copy
handed over to the patient, pharmacist retains
second copy and third copy is submitted for
the auditing
91. PRESCRIPTION AUDIT METHODOLOGY
• It’s not fault finding or blame game exercise
but a fact finding effort.
• It’s not about who went wrong, but on
identifying what went wrong and why did it
happen??
• Done every month in high throughput
facilities and done every three months in low
throughput facilities
92. PRESCRIPTION AUDIT COMMITTEE
• Hospital in-charge (MS)
• Prescription auditor from AMS team
• One clinician from each department
• In-charge nursing services
• In-charge of hospital pharmacy
93. PRESCRIPTION AUDIT – DATA
COLLECTION METHOD
• Data collection – Simple random sampling
• Numerator – Patient demographics,
completeness of prescription related
attributes and Antibiotic stewardship related
attributes
• Denominator – Number of samples
94. ANTIBIOTIC TIME OUTS
• It involves scheduled reassessment of the
choice of antibiotics and need for continuing
the antibiotic, when the clinical picture is
clearer and more diagnostic information
(Eg: culture report) is available
96. DOSAGE OPTIMIZATION
• The concept of dosage optimization is needed
to ensure that the appropriate and effective
antimicrobial therapy is administered while
minimizing the possibility of adverse drug
reactions and suboptimal therapy
97. AUTOMATED ALERTS
Automated alerts integrated with response and
intervention by the AMS team can be a very
effective stewardship strategy.
IT CAN BE EITHER:
• Clinical microbiological alert
• Pharmacy alert
• AMS advice alert
98. EDUCATIONAL INTERVENTIONS
• It leads to increasing the knowledge,
rationalizing the practice and improving the
attitude is considered as an important and
core persuasive AMS interventions.
• Educational interventions can be carried out
both for clinicians and patients/general public
100. LOW HANGING FRUITS
• It refers to the implementation of the most
obtainable targets (Interventions) with limited
resources first rather than confronting more
complicated resource intensive interventions.
EXAMPLES:
• IV to oral conversion
• Batching of IV antimicrobials
• Culture sent before antimicrobial start
103. MINDME STRATEGY
• Microbiology guides therapy, wherever
possible
• Indications should be evidence based
• Narrowest spectrum required
• Dosage individualised to the patient
• Minimize the duration of therapy
• Ensure oral therapy is used, where clinically
appropriate
104. INTERVENTIONS TO CONTROL OTC SALE
PROPERTIES SCHEDULE H SCHEDULE H1
Treatment
PROPERTIES SCHEDULE H DRUGS SCHEDULE H1 DRUGS
Treatment Black colour Red colour
Warning box label Box with black border to be
sold by prescription of
RMP only
Box with red border to be
sold by prescription of
RMP only
(RED LINE CAMPAIGN
INITIATED IN 2016)
Register maintenance Not required Maintained for 3 years
Introduced in 1945 Drug and cosmetic
rules
Revised in 2014
106. BACK UP PRESCRIPTION
• A back up (Delayed) prescription is a
prescription (Which can be post dated) given
to a patient or his care giver with the
assumption that it will not be dispensed
immediately, but will be dispensed in a few
days if symptoms worsen.
• We can give it directly to the patient care giver
or local pharmacy
109. BEHAVIOURAL INTERVENTIONS
• AMS requires a range of behaviours such as
following guidelines assessing the benefits
and risks of treatment; choosing the
appropriate drug, route or dose and
administering the antibiotic at the appropriate
time, at the correct frequency and for the
appropriate
111. MAHATHMA GANDHI ONCE SAID...
• “YOUR BELIEFS BECOME
YOUR THOUGHTS,
YOUR THOUGHTS
BECOME YOUR WORDS,
YOUR WORDS BECOME
YOUR ACTIONS, YOUR
ACTIONS BECOME
YOUR HABITS, YOUR
HABITS BECOME YOUR
VALUES”
116. TYPES OF MEASUREMENTS IN AMS
• Outcome measures – “Did the process
implemented directly lead to an intended
outcome (Reduction in resistance or
antimicrobial consumption or other
unintended consequences of antimicrobial
use)”
• Process measures – “Whether the
intervention is properly implemented and
resulted in a desired change in the process
factors (Eg: De-escalation) and that leads to an
intended outcome”
117. DATA SOURCE FOR ANTIMICROBIAL
USAGE
TWO TYPES
• Geographical location specific data source
• Health care facility level data source
118. DATA SOURCE
GEOGRAPHICAL LOCATION SPECIFIC DATA HEALTH CARE FACILITY LEVEL DATA
Manufacturer level Procurement data
Pharmacies level data Dispensing data
Prescribing records Prescription data
Health insurance data Nursing chart data
Community survey Patient level data
119. ANTIMICROBIAL CONSUMPTION AND
USE
ANTIMICROBIAL CONSUMPTION (AMC):
• Estimates derived from data, which provides an
overall indirect proxy estimate on the usage of
antimicrobials
• Facility based data
ANTIMICROBIAL USE (AMU)
• Represents the direct estimate of use of
antimicrobials derived from patient level data i.e.
The quantity of antimicrobials the patients have
actually consumed.
First we have to follow AMC...once well
implemented we can move on to AMU
120. ATC (Anatomical Therapeutic Chemical) CLASSIFICATION SYSTEM
(Most commonly used system to analyse parameters)
Five levels are there.....
LEVEL – 1:
• Anatomical (Pharmacological) main group
• Represented by alphabet
Examples:
J – Antimicrobials of systemic use
A – Intestinal antimicrobials
P – Anti parasitic drugs
121. ATC (Anatomical Therapeutic Chemical) CLASSIFICATION SYSTEM
(Most commonly used system to analyse parameters)
LEVEL-2:
• Therapeutic (Pharmacological) subgroups
• Represented by numbers
Examples:
J01 – Antibacterial agents of systemic use
J02 – Anti fungal agents
J04 – Anti mycobacterial agents
J05 – Anti viral agents
P02 – Anti helminthic agents
122. ATC (Anatomical Therapeutic Chemical) CLASSIFICATION SYSTEM
(Most commonly used system to analyse parameters)
LEVEL – 3:
• Pharmacological (Chemical/therapeutic)
subgroups
• Represented by alphabets
Examples:
J01C – Beta lactams
P01B – Anti malarial agent
P02C – Anti nematode agents
123. ATC (Anatomical Therapeutic Chemical) CLASSIFICATION SYSTEM
(Most commonly used system to analyse parameters)
LEVEL – 4:
• Chemical (Pharmacological/therapeutic)
subgroups
• Represented by alphabets
Examples:
J01CA – Extended spectrum penicillins
P02CA – Benzimidazoles
124. ATC (Anatomical Therapeutic Chemical) CLASSIFICATION SYSTEM
(Most commonly used system to analyse parameters)
LEVEL – 5:
• Chemical substance (i.e. Actual drug)
• Represented by numbers
Examples:
J01CA01 – Ampicillin
J01CA012 – Amoxycillin
P02CA03 – Albendazole
125. DEFINED DAILY DOSE (DDD)
• Average maintenance dose per day for a drug
used for its main indication in adults.
• DDD has been assigned only for antimicrobial
agents that have ATC code
• It is a unit of technical measurement used to
measure the drug usage and it does not
necessarily correspond to the recommended
therapeutic dose for prescribed daily dose.
126. ASSIGNING DDD VALUES
In general – DDD value will be calculated based
on daily dosage regimen
In loading dose & maintenance dose scenario –
DDD will be calculated as follows:
• Duration of therapy >7 days = Maintenance
dose per day
• Duration of therapy ≤7 days = Loading dose +
Average of daily Maintenance dose divided by
duration of treatment
128. ANTIMICROBIAL CONSUMPTION
VOLUME
• Calculated by dividing the amount of
antimicrobial agent (measured in grams) by
the DDD value (In grams) that has been
assigned to the respective antimicrobial agent
by the WHO CC
• DDD value (In grams) based on package level
data and Substance level data
129. DDD CALCULATION FOR
COMBINATION PRODUCTS
• Product with only one active agent (Regular
DDD calculation)
• Product with ≥2 active agents – Unit dose
UNIT DOSE:
• One tablet or vial of a combination product
with specific strength of each component is
defined as unit dose
130. ANTIMICROBIAL CONSUMPTION
DENSITY
• Antimicrobial consumption will vary
depending on the size of population in the
geographical region, hospital inpatient and
outpatient count.
BASED ON THREE VARIABLES:
• Based on geographical region specific data
• Based on facility specific inpatient data
• Based on facility specific outpatient data
131. BASED ON FACILITY SPECIFIC INPATIENT DATA
Denominators will be:
• Patient days
• Days present
• Bed days
• Occupied bed days
• Admissions
• Billing days
• Discharges
132. BASED ON FACILITY SPECIFIC OUTPATIENT DATA
Denominators will be:
• Number of outpatients attended
• Number of outpatients prescriptions
133. GRANULARITY
• The concept of granularity means that the
more the data is collected in-depth from the
lowest possible data sources, the more
detailed analysis can be performed with the
existing data
134. DECREASING ORDER OF GRANULARITY
• Dispensing level data
• Procurement level data
• Distribution level data
• District level data
• State level data
• National level data
137. AMC TOOL
• It is an open source program to calculate
antimicrobial consumption collected as
packages data and converts into numbers of
defined daily doses (DDD) using ATC/DDD
index
• Successor of the old tool called as ‘ABC Calc’
• Manual data entry or imported from CSV
file/Excel file
138. DAYS OF THERAPY (DOT)
• It is the number of days that patient receives
at least one dose of an antibiotic summed for
each antimicrobial agent.
• Like DDD, It is also having two analysis DOT
consumption volume and density
• Since it’s independent of dosage and
frequency we can use it for pediatrics also
139. STANDARD ANTIMICROBIAL
ADMINISTRATION RATIO (SAAR)
• It is calculated as the ratio of observed and
predicted antimicrobial use
• If SAAR>1 = Overuse of antimicrobials than
predicted
• If SAAR<1 = Underuse of antimicrobials than
predicted
• If SAAR=1 = Equivalent use of antimicrobials
than predicted
140. POINT PREVALENCE SURVEY (PPS)
• It is a qualitative indicator of antimicrobial
consumption
• It refers to the collection of antimicrobial
treatment data from hospitalized patients at a
fixed point of time
141. PRESCRIBED DAILY DOSE (PDD)
• It is defined as the average dose prescribed
according to a representative sample of
prescriptions.
142. ANTIMICROBIAL FREE DAYS (AFD)
• It is defined as the total number of days when
no antimicrobial agents were administered to
the patient during a single episode of
hospitalization.
143. PROPORTION OF PATIENTS ON
ANTIMICROBIAL THERAPY
• It is defined as the proportion of patients in a
health care facility receiving antimicrobial
therapy for a given period of time out of total
number of patients attending at facility for the
same time period.
145. MORTALITY INDICATORS
• All in cause hospital mortality
• All in cause 30 day mortality
• Infection specific mortality
• MDRO related mortality
• Standardized mortality ratio
146. MORBIDITY INDICATORS
• All-cause length of stay in hospital
• Infection specific length of stay in hospital
• Stratified infection specific length of stay in
hospital
• Proportion of patients with clinical failure
• All cause readmission within 30 days
• Infection related readmission within 30 days
• Ward to ICU transfer rate
• Antimicrobial related toxicity rate
149. PROCESS MEASURES
Based on compliance to guidelines
• Empirical treatment guidelines
• Targeted treatment guidelines
• Surgical prophylaxis guidelines
• Prescription related process indicators
• Diagnostic related process indicators
• Administrative correctness indicators
Structural and Infection control process indicators
150. NATIONAL RESPONSE TO AMR IN
INDIA
• 2010 – National task force
• 2011 – National policy for AMR containment
• 2011 – Jaipur declaration on AMR
• 2012 – Chennai declaration to tackle AMR
• 2017 – Delhi declaration
• 2017-2021 = NAP-AMR
• 2022-2026 = NAP-AMR 2.0
153. NAP-AMR 2.0 (2022-2026)
• NCDC, Government on India in collaboration with
WHO India and Infectious Diseases Detection and
Surveillance (IDDS) planned a series of sectoral
and intersectoral consultations to obtain inputs
from experts on the status of implementation of
NAP-AMR, challenges and lessons learnt.
• There is proposal came for adding AMC
surveillance in strategic priority 2. (Previously in
strategic priority 4)
154. STATE ACTION PLAN ON AMR
• Kerala started it first on 2018
• Madhya pradesh in 2019
• Delhi in 2020
SAP in other states (Under process for
implementation)
• Andhra pradesh, Telangana, Tamilnadu,
Maharashtra, Goa, Puducherry, Karnataka
155. GLOBAL PARTNERS FOR AMR IN INDIA
CDC – India
• HAI surveillance network
• NARS-net (National Antimicrobial Resistance
Surveillance Network)
WHO-India
• CSS (Country cooperation strategy)
• WHONET
• GLASS (Global Antimicrobial Resistance and Use
Surveillance System)
• WINSAR
156. GLOBAL PARTNERS FOR AMR IN INDIA
• FAO
• USAID (United States Agency for International
Development)
• World bank
• Fleming fund
• ReAct
157. NATIONAL NETWORKS PARTICIPATION
FOR AMR IN INDIA
• ICMR is taking care of AMR surveillance and
research, HAI surveillance, Antimicrobial
stewardship and infection control
• NCDC – AMR surveillance
• CDC – HAI surveillance
158. Centres enrolled for National
programme on AMR in Tamilnadu
• Coimbatore medical college
• KAPV Government medical college, Trichy
159. ICMR PROJECT ON AMS PROGRAM
FIRST PHASE AMSP PROJECT (2018-2021)
• Initiating AMS activities in Hospitals in India
• Successfully implemented in 20 hospitals (12
government sectors and 8 private hospitals)
SECOND PHASE AMSP PROJECT (2022-2025)
• Implementation of AMSP in various tertiary
care hospitals in India based on the results of
phase-1.
161. CORE ELEMENTS OF OUTPATIENT AMS
• Commitment
• Action for policy and practice
• Tracking and reporting
• Education and expertise
162. AMS IN OUTPATIENT PARENTERAL
ANTIMICROBIAL THERAPY (OPAT)
• OPAT – Administration of parenteral antimicrobial
therapy in at least two doses on different days
without intervening hospitalization.
• Core OPAT team – OPAT specialist nurse, Doctor,
ID physician or clinical microbiologist, Pharmacist
• At-least weekly review of OPAT patients, and have
to give training on IV line care along with hand
hygiene, Inspection of insertion of IV line site ....
163. AMS IN LONG TERM FACILITY CENTRES
(LTCFs)
• LTCFs – They are the centres that provide services
to people (Usually old age) with their medical
needs or daily activities over a long period of
time when they can no longer perform everyday
activities on their own.
• Empower the medical director to set standards
for prescribing antimicrobials for LTCFs patients
• Empower the Nursing superintendent to set the
practice standards of front line staff nurses for
providing care
164. ONE HEALTH APPROACH IN
INTEGRATED STEWARDSHIP
• Stewardship measures implemented to contain
AMR must address all the interconnected
domains of one health – human, animal and
environment
• Done by FAO-OIE-WHO-UNEP quadripartite
commitment
• Since 2010, It’s tripartite....On 17th march 2022,
UNEP is added (United Nations Environmental
program) as fourth partner
• OIE (Office International des Epizooties)...Now
this is updated to WOAH (World Organization for
Animal Health)
165. ONE HEALTH HIGH LEVEL EXPERT
PANEL (OHHLEP)
• The advisory panel of OHHLEP whose members
represent a broad range of disciplines in science
and policy related sectors relevant to one health
around the world formulated a new operational
definition called as one health approach.
• One health is defined as an “Integrated, unifying
approach that aims to sustainably balance and
optimize the health of people, animals and
ecosystems
• International One Health Day – November 3rd
every year
166. ENVIRONMENTAL STEWARDSHIP
SPREAD OF AMR BY EITHER
• Gene transfer (i.e. Mutation from pre existing
genome)
• Horizontal gene transfer (A novel
Antimicrobial Resistance Genes (ARGs) from
environment)
167. HORIZONTAL GENE TRANSFER
• 1st step – Initiated by the ability of donor
bacterium to move the ARG within the genome
• 2nd step – Relocation of ARG to an element called
as conjugative plasmid, so that ARG can move
freely between cells
• 3rd step – Horizontal transfer of ARG either
directly in environment or through several
bacterial hosts
• 4th step – Physical transfer of bacterium carrying
ARG from environment to the human or domestic
animal microbiota (Ecological connectivity)
169. VETERINARY STEWARDSHIP
• Injudicious use of antimicrobials in animals
increasing the antibiotic resistance.
• Other than therapeutic use, penicillin,
tetracycline, colistin, avoparcin(Glycopeptide),
streptogramin, tylosin (Macrolide) were used
for growth promotion, egg production, milk
production.
COLISTIN BANNED IN INDIA AS AN ANIMAL FEED
170. NO ANTIBIOTICS..... FOR
VETERINARIES....
• For therapeutic – Vaccination, Immune
modulators, Phage therapy
• For non-therapeutic (Growth promotors) – Pre
and probiotics, Infeed enzymes,
Phytochemicals, Clay minerals.....
171. FISHERIES STEWARDSHIP
PROGRAMME
• Eventhough the use of antimicrobials inn
fishereies plays a minor role in antimicrobial
resistance, stewardship measures should not be
ignored.
• Mainly used in ponds and tanks
• In ocean (Marine water) calcium and magnesium
ions decrease the biological activity of
oxytetracycline and fluroquinolones by forming
divalent cation complex and it leads to
antimicrobial effect loss within a month......
172. MEASURES TAKEN IN AGRICULTURAL
STEWARDSHIP
• FAO launched InFarm IT platform in 2022.
• Each country should upload data in POMS
(Plantwise Online management system)
173. HOSPITAL SOURCE CONTROL – UNMET NEED OF
AN INTEGRATED ANTIMICROBIAL STEWARDSHIP
1) Timely identification of MDR PEAK ME infections
2) Isolation room for that patients
3) Environmental cleaning after shifting that
patient
4) Following correct antimicrobial guidelines
5) Timely de-isolation of the patient
6) Local ground working team to monitor IPC
practices
174. MAJOR IPC PRACTICES OF SOURCE
CONTROL
• Hand hygiene
• PPE
• Single use of patient dedicated equipment
• Following bundle care approach in CAUTI,
CLABSI, SSI, VAP and Ryle’s tube
• Body care
• HCW vaccination
175. ANTIBIOGRAM
• Overall profile of antimicrobial susceptibility testing
results of a specific microorganism to a battery of
antimicrobial agents
TYPES:
• Routine cumulative antibiograms
• Enhanced antibiograms (Location/ICU/Population
wise/Age wise)
• Subtraction antibiogram (Comparing with last year)
• Atleast 30 isolates should be available for each
organism to kept ready antibiogram
• Should be done annually (Even six months once /more
frequently if no. of isolates in each organism is more
than 30)
176. MIC CREEP
• MIC values are not included in antibiogram
• As a result, subtle trends below the resistance
threshold are not reflected
177. ANTIFUNGAL STEWARDSHIP
• AFS is a component of AMS where
antibacterial drugs are replaced by antifungal
drugs
• AMS team should have mycologist.
• AFS program is yet to start in our country
• Main efforts are made to shift prophylactic
therapy to empirical, empirical to pre-
emptive, pre-emptive to targeted therapy
178. ANTIVIRAL STEWARDSHIP
• Immunocompromised patients are at
increased risk of acquiring a number of
opportunistic viral infections-the most
common is CMV. (Anti CMV stewardship)
• Anti RSV stewardship