Reduction of Antimicrobial Resistance and Limiting Use of Antibiotics by the Application of De-escalation and Streamlining: A Review Update

2020 ◽  
Vol 6 (2) ◽  
pp. 140-142
Author(s):  
Ritu Saha ◽  
Bhuiyan Mohammad Mahtab Uddin
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Drug Resistant ◽  
Critical Component ◽  
Resistance Development ◽  
The Real ◽  
Different Types

De-escalation is a critical component that lies at the center of antimicrobial stewardship programs. It is a clinically effective concept in reducing infection with drug resistant isolates. Although there is significant and serious shortfalls like establishment of the real impact of de-escalation on antimicrobial resistance development; it is now well demonstrated that there is no harm for patients, whether it genuinely improve clinical outcomes. Further studies are needed to establish the most effective tools to implement de-escalation, particularly in terms of providing clear guidelines to clinicians to enable them to be confident in applying this maneuver in our country. It is interesting that this concept of de-escalation is now being explored in different types of infection. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 140-142

scholarly journals 110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Katie A McCrink ◽  
Kailynn DeRonde ◽  
Adriana Jimenez ◽  
Gemma Rosello ◽  
Yoichiro Natori ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Patient Survival ◽  
Intervention Group ◽  
Culture Collection ◽  
Drug Resistant ◽  
Intervention Period ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

scholarly journals mSphere of Influence: Evolutionary Strategies To Sensitize Drug-Resistant Pathogens

mSphere ◽  
2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Rebecca S. Shapiro
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Genetic Interaction ◽  
Interaction Networks ◽  
Evolutionary Strategies ◽  
Drug Resistant ◽  
Bacterial Evolution ◽  
Resistance Development ◽  
Collateral Sensitivity ◽  
Link Type

ABSTRACTRebecca S. Shapiro studies antimicrobial resistance and genetic interaction networks. In this mSphere of Influence article, she reflects on how the papers “Bacterial evolution of antibiotic hypersensitivity” by Lázár et al. (V. Lázár, G. Pal Singh, R. Spohn, I. Nagy, et al., Mol Syst Biol 9:700, 2013,https://doi.org/10.1038/msb.2013.57) and “Use of collateral sensitivity networks to design drug cycling protocols that avoid resistance development” by L. Imamovic and M. O. A. Sommer (Sci Transl Med 5:204ra132, 2013,https://doi.org/10.1126/scitranslmed.3006609) impacted her thinking about multigene interaction effects on drug resistance.

scholarly journals Unorthodox Parenteral β-Lactam and β-Lactamase Inhibitor Combinations: Flouting Antimicrobial Stewardship and Compromising Patient Care

2020 ◽  
Vol 64 (5) ◽  
Author(s):  
Snehal Palwe ◽  
Balaji Veeraraghavan ◽  
Hariharan Periasamy ◽  
Kshama Khobragade ◽  
Arun S. Kharat
Keyword(s):  
Clinical Practice ◽  
Drug Development ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Fixed Dose ◽  
Resistance Development ◽  
Safety And Efficacy ◽  
India And China ◽  
Lactamase Inhibitor

ABSTRACT In India and China, indigenous drug manufacturers market arbitrarily combined parenteral β-lactam and β-lactamase inhibitors (BL-BLIs). In these fixed-dose combinations, sulbactam or tazobactam is indiscriminately combined with parenteral cephalosporins, with BLI doses kept in ratios similar to those for the approved BL-BLIs. Such combinations have been introduced into clinical practice without mandatory drug development studies involving pharmacokinetic/pharmacodynamic, safety, and efficacy assessments being undertaken. Such unorthodox combinations compromise clinical outcomes and also potentially contribute to resistance development.

Antimicrobial Stewardship

2019 ◽  
Author(s):  
Sarfaraz Ameen ◽  
Caoimhe NicFhogartaigh
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Length Of Hospital Stay ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Global Public Health ◽  
National Guidelines ◽  
Minor Operations ◽  
The Right

Antimicrobial stewardship (AMS) is a healthcare- system- wide approach to promoting and monitoring the judicious use of antimicrobials (including antibiotics) to preserve their future effectiveness and optimize outcomes for patients. Put simply, it is using the right antibiotic, at the right dose, via the right route, at the right time, for the right duration (Centres for Disease Control, 2010). Antimicrobial resistance (AMR) is a serious and growing global public health concern. Antibiotics are a unique class of drug as their use in individual patients may have an impact on others through the spread of resistant organisms. Antibiotics are essential for saving lives in conditions such as sepsis, and without effective antibiotics even minor operations could be life-threatening due to the risk of resistant infections. Across Europe approximately 25,000 people die each year as a result of hospital infections caused by resistant bacteria, and others have more prolonged and complicated illness. By 2050, AMR is predicted to be one of the major causes of death worldwide. Protecting the use of currently available antibiotics is crucial as discovery of new antimicrobials has stalled. Studies consistently demonstrate that 30–50% of antimicrobial prescriptions are unnecessary or inappropriate. Figure 18.1 shows some of the reasons behind this. As well as driving increasing resistance, unnecessary prescribing leads to unwanted adverse effects, including avoidable drug reactions and interactions, Clostridium difficile-associated diarrhoea, and healthcare-associated infections with resistant micro-organisms, all of which are associated with adverse clinical outcomes, including increased length of hospital stay and mortality, with increased cost to healthcare systems. Prudent use of antibiotics improves patient care and clinical outcomes, reduces the spread of antimicrobial resistance, and saves money. There are a number of global and national guidelines outlining what a robust AMS programme should consist of (see Further reading and useful resources), including: ● Infectious Diseases Society of America (IDSA): Guidelines for Developing an Institutional Programme to Enhance Antimicrobial Stewardship. ● National Institute for Health and Care Excellence (NICE): Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use [NG15]. ● Department of Health (DoH): Start Smart Then Focus, updated 2015. ● DoH: UK 5- Year Antimicrobial Resistance Strategy 2013 to 2018.

scholarly journals Challenges for a sustainable financial foundation for antimicrobial stewardship

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Jan-Willem H. Dik ◽  
Bhanu Sinha
Keyword(s):  
Antimicrobial Resistance ◽  
Economic Impact ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Stewardship Program ◽  
Resistance Development ◽  
Institutional Level ◽  
Know How ◽  
Stewardship Program ◽  
Single Process ◽  
Diagnostics And Therapy

Antimicrobial resistance is a worldwide threat and a problem with large clinical and economic impact. Antimicrobial Stewardship Programs are a solution to curb resistance development. A problem of resistance is a separation of actions and consequences, financial and clinical. Such a separation makes it difficult to create support among stakeholders leading to a lack of sense of responsibility. To counteract the resistance development it is important to perform diagnostics and know how to interpret the results. One should see diagnostics, therapy and resistance as one single process. Within this process all involved stakeholders need to work together on a more institutional level. We suggest therefore a solution: combining diagnostics and therapy into one single financial product. Such a product should act as an incentive to perform correct diagnostics. It also makes it easier to cover the costs of an antimicrobial stewardship program, which is often overlooked. Finally, such a product involves all stakeholders in the process and does not lay the costs at one stakeholder and the benefits somewhere else, solving the misbalance that is present nowadays.

scholarly journals Where To From Here? Identifying and Prioritizing Future Directions for Addressing Drug-Resistant Infection in Australia

2020 ◽  
Vol 41 (S1) ◽  
pp. s434-s434
Author(s):  
Lisa Hall ◽  
Greg Merlo ◽  
Minyon Avent ◽  
Trent Yarwood ◽  
Bonnie Smith ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Implementation Strategies ◽  
Audit And Feedback ◽  
Care Hospital ◽  
Drug Resistant ◽  
Implementation Barriers ◽  
Resistant Infection

Background: The Australian Government released a national strategy for antimicrobial resistance in 2015 that calls for a collaborative effort to change practices that have contributed to the development of drug-resistant infection and for the implementation of new initiatives to reduce antibiotic use. Although many achievements have been made in antimicrobial stewardship (AMS), particularly in the acute-care hospital setting, progress more broadly has been slow, and novel solutions are now required to improve clinical practice and community awareness. A facilitated workshop was undertaken at the 2019 National Australian Antimicrobial Resistance Forum to explore the complexity of AMS implementation in Australia and to prioritize future action. Methods: Participants engaged in rotating rounds of discussion using a world café format. The participants sat face-to-face at tables of 7 or fewer. At each table were 2 facilitators: one was a note taker and the other was the discussion leader. Each of the 6 facilitator pairs had a topic for discussion related to implementing antimicrobial stewardship in different contexts, with a focus on experience with strategies that have worked, major implementation barriers, and prioritizing the next steps. The topics for discussion included (1) engaging with hospital staff; (2) implementation in resource-poor settings; (3) implementation in primary care and aged care; (4) engaging and empowering the public; (5) linking data with implementation strategies; and (6) leadership. The facilitators moved between tables at 15-minute intervals to encourage evolving rounds of conversation. Once all tables had discussed all of the themes, the discussion concluded and notes were summarized. A qualitative analysis using an interpretive description approach was conducted using the discussion summaries. The documents were independently openly coded by 2 researchers to identify elements relating to the implementation of antimicrobial stewardship. An iterative approach was used to identify themes and reach a consensus on overarching emergent themes from the workshop. Results: In total, 39 experts (ie, pharmacists, infectious disease physicians, infection prevention nurses, researchers, journalists and consumers) participated in the facilitated discussions. Strategies were discussed relating to engaging with clinicians, consumers, and politicians; adapting to funding, governance, and accreditation limitations; and models for outreach of antimicrobial services. Other themes included the role of clinical champions and mentors as leaders and improving use of audit and feedback through focusing on monitoring appropriateness rather than usage. Conclusions: Recommendations from the workshop will be used to prioritize novel ideas to improve the implementation of AMS initiatives across Australia.Funding: NoneDisclosures: None

scholarly journals Antimicrobial stewardship: need of the hour

2018 ◽  
Vol 7 (8) ◽  
pp. 1444
Author(s):  
Razi Ahmad ◽  
Sana Rehman
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Animal Health ◽  
Medical Procedures ◽  
Drug Resistant ◽  
Minimal Impact ◽  
Global Threat ◽  
Prolonged Hospital ◽  
The Continuum

Efforts to tackle the global threat of Antimicrobial Resistance (AMR) have recently taken shape in a number of potentially far-reaching collaborative initiatives. When microbes become resistant to medicines, the options for treating the diseases they cause are reduced. This resistance to antimicrobial medicines is happening in all parts of the world for a broad range of microorganisms with an increasing prevalence that threatens human and animal health. The direct consequences of infection with resistant microorganisms can be severe, including longer illnesses, increased mortality, prolonged hospital stay, loss of protection for patients undergoing operations and other medical procedures, and increased costs. Antimicrobial resistance affects all areas of health, involves many sectors and has an impact on the whole of society. To overcome the threat of antimicrobial resistance, a three-pillar approach has been advocated i.e. Optimize the use of existing antimicrobial agents, prevent the transmission of drug-resistant organisms through infection control and Improve environmental decontamination. Antimicrobial stewardship [AMSP] is one of the key strategies to overcome resistance. It is an inter-professional effort, across the continuum of care, involves timely and optimal selection, dose and duration of an antimicrobial for the best clinical outcome for the treatment or prevention of infection with minimal toxicity to the patient and minimal impact on resistance and other ecological adverse events.

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