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Antibiotic stewardship , Doaa Abdel Rahman.pptx
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- 3. Objectives Antibiotic resistance Antibiotic stewardship (AS) CDC elementsof AS Egypt’s National Action Plan 01 02 04 05 Goals Callenges 03 06
- 4. Antibiotics areone of the most important discoveries in modern medicine. Antibiotics are the most precious drugs in the Medical Field” up till now !!!. However, inappropriate knowledge of the proper use of antibiotics may lead to entering the antibiotic dilemma Antibiotics
- 5. Antibiotics Dilemma The dilemmasurrounding antibiotic use is that the inappropriate use of antibiotics may lead to ‘collateral damage’ Misuse or overuse Severe restriction (inadequate therapy) Development of resistance In seriously ill patients is associated with increased mortality
- 8. Bacteria are generousthey give each other gifts of resistance elements
- 9. Antimicrobial resistance results in: ●Increased morbidity ● Increased mortality ● Increased cost of treatment
- 10. Fighting Back! Prevent infections 1 Preventthe spread of resistance 2 Developing new drugs and diagnostic tests 3 ANTIBIOTIC STEWARDSHI P 4 The CDC has recommended four necessary actions to prevent antimicrobial resistance
- 11. Antibiotic Stewardshi p How to fightthe most resistant micobes
- 12. What is Antimicrobial stewardship •It is a set of coordinated measures designed to improve and measure the appropriate use of antimicrobials. • This is done by promoting the optimal antimicrobial course of treatment, dosage, duration of therapy and the way in which the medication is taken • Leading to improved patient outcomes and decreased adverse events
- 13. . WHY WENEED ANTIBIOTIC STEWARDSHIP ?! - Antimicrobial resistance is increasing; however, antimicrobial drug development is slowing. -Now more than ever before, Antimicrobial stewardship is of the most importance as a way to optimize the use of antibiotics to prevent the development of resistance and improve
- 14. Goals of antibiotic stewardship Thegoal is… to have the RIGHT DRUG for the RIGHT PERSON over the RIGHT TIME FRAME
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- 16. • Core membersof a antimicrobial stewardship team include an infectious diseases physician (usually director). A clinical pharmacist with infectious diseases training. With the inclusion of a clinical microbiologist, an information system specialist, an infection control professional. • Collaboration between the antimicrobial stewardship team and the hospital infection prevention and control team is essential • The support and collaboration of the hospital administration is essential in the development and maintenance of antimicrobial stewardship programs to give the team adequate authority, compensation, to improve the expected outcomes for the program Antibiotic stewardship team members
- 17. The CDC’s CoreElements of Antibiotic Stewardship Hospital Antibiotic Stewardsh ip Programs Outpatien t Antibiotic Stewardsh ipProgram s
- 18. a. Leadership Commitment:Hospital leadership should actively support and promote antibiotic stewardship efforts. b. Accountability: Establish clear roles and responsibilities for implementing stewardship activities. c. Pharmacy Expertise: Involve pharmacists with expertise in infectious diseases and antimicrobial management. d. Action: Implement evidence-based practices to optimize antibiotic use. e. Tracking and Reporting: Regularly monitor antibiotic use and resistance patterns. f. Education: Educate healthcare providers, staff, and patients about Hospital Antibiotic Stewardship Programs
- 19. a. Commitment: Demonstratecommitment to improving outpatient antibiotic use. b. Action for Policy and Practice: Implement policies and practices to promote appropriate prescribing. c. Tracking and Reporting: Monitor antibiotic prescribing patterns and outcomes. d. Education: Educate healthcare providers and patients about antibiotic use Outpatient Antibiotic Stewardship:
- 20. Antibiotic Stewardship Booklet ● Theobjective of this booklet is to provide practical recommendations for healthcare workers in hospitals to improve the quality of antibiotic prescribing and thereby improve patient clinical outcomes. Stewardship-Booklet-Practical-Guide-to-Antimicrobial-Stewardship-in-Hospitals.pdf (bsac.org.uk)
- 21. 1) Consider whetheror not the patient actually requires an antibiotic. Additional Element for Antibiotic stewardship
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- 23. Additional Element forAntibiotic stewardship 2) Education: It is considered to be an essential element of any program. It may include passive activities, such as Conference presentations, Student and house staff teaching sessions, E-mail alerts. Written guidelines
- 24. 3) Guidelines toantibiotic prophylaxis of SSI should consider Risk factors for SSI Common pathogens Operation performed (elective or emergency) Duration of operation Classification of operation Justification for prophylaxis Number of doses given Additional Element for Antibiotic stewardship
- 25. Additional Element forAntibiotic stewardship 4) Duration of antibiotic therapy ● Give the antibiotic for the minimum length of time that is effective. ● In general do not change antibiotic therapy if the clinical condition is improving. ● If there is no clinical response within 72 hours, the clinical diagnosis, the choice of antibiotic and/or the possibility of a secondary infection should be reconsidered
- 26. 5) Combination therapy •Combination therapy does have a role in certain clinical conditions, including: Empirical therapy for critically ill patients at risk of infection with MDR pathogens Mixed infections Immunocompromised patients Febrile neutropenia • There are insufficient data to recommend the routine use of combination therapy to prevent the emergence of resistance Additional Element for Antibiotic stewardship
- 27. Additional Element forAntibiotic stewardship 6) De-escalation of empirical therapy: • Continuing excessively broad therapy contributes to the selection of antimicrobial resistant pathogens • So de-escalation of empirical antimicrobial therapy on the basis of culture results and elimination of redundant combination therapy can more effectively target the causative pathogen ,resulting in decreased antimicrobial exposure and substantial cost savings
- 28. Additional Element forAntibiotic stewardship 7) Dose optimization: Optimization of antimicrobial dosing based on individual patient characteristics, causative organism, site of infection, and pharmacokinetic and pharmacodynamic characteristics of the drug is an important part of antimicrobial stewardship 8) Parenteral to oral conversion: A systematic plan for parenteral to oral conversion of antimicrobials, when the patient’s condition allows, can decrease the length of hospital stay and health care costs .
- 29. Additional Element forAntibiotic stewardship 9) Computer Surveillance and Decision Support • A program presents epidemiologic information with detailed recommendations and warnings regarding antimicrobial regimens and courses of therapy. • It can facilitate good stewardship by more efficient targeting of antimicrobial interventions, tracking of antimicrobial resistance patterns, and identification of nosocomial infections and adverse drug events 10) Electronic medical records Can improve antimicrobial decisions through the incorporation of data on patient-specific microbiology cultures and susceptibilities, hepatic and renal function, drug-drug interactions, allergies, and cost.
- 32. Egypt’s National ActionPlan for Antimicrobial Resistance ○ In 2018, Egypt developed a National Action Plan to address antimicrobial resistance. This plan outlines strategies and interventions to combat AMR from 2018 to 2022. ○ The plan likely includes elements such as: ■ Surveillance: Monitoring antibiotic use, resistance patterns, and AMR-related infections. ■ Education: Raising awareness among healthcare providers, patients, and the public. ■ Guidelines: Developing evidence-based guidelines for antibiotic use. ■ Stewardship Programs: Implementing stewardship initiatives
- 33. ● Status of Antimicrobial Stewardship Implementationin Selected Egyptian Hospitals: A Cross- sectional Study Hamdy N, Kandil NH, Amer AN. Status of Antimicrobial Stewardship Implementation in Selected Egyptian Hospitals: A Cross-sectional Study. Egyptian Journal of Medical Microbiology. 2022 Apr 3;31(2):77-83.
- 34. 34 Antibiotic stewardship programs inEgyptian hospitals ● There are some successful ASP in Egyptian hospitals as in Ain-Sham University hospital, Cairo University Specialized Pediatric Hospital, some of Zagazig and Alexandria hospitals ● Egyptian hospitals have a good ASP implementation which is very effective in optimizing antibiotics use and leads to favourable outcomes in terms of decreased length of therapy, hospital stay, and mortality rate of the patients Wassef MA, Sayed AM, Aziz HS, Meligy B, Halim MM. Implementation and evaluation of antimicrobial stewardship program in medical ICU in Cairo university specializ pediatric hospital. Open Access Macedonian Journal of Medical Sciences. 2020 Aug 25;8(B):716-22. Salem MR, Youssef MRL, Shalaby SF, Mahmoud AT, Ismail M, Ibrahim SK. Perspectives on Antibiotic Stewardship Programs among Health Care Provid at Two University Hospitals in Egypt. Int J Environ Res Public Health. 2023 Feb 21;20(5):3777. doi: 10.3390/ijerph20053777. PMID: 36900787; PMCID: PMC10001175. Salah, Akram & Elhossaieny, Ghadir & Elleboudy, Nooran & Yassien, Mahmoud. (2021). Antimicrobial Stewardship Programs: A Review. Archives of
- 35. • Challenges facingEgypt include high prevalence of infectious diseases, weak health systems, and misuse of antimicrobials • Also, IT support programs, cooperation between healthcare members, monitoring, and continuous trainings are still needed. . Challenges :
- 36. 36 Take home message ●Antimicrobial resistance is a major problem and Antibiotic stewardship programs are a major part of the solution ● Learn the CDC core elements and understand how to employ them in your practice ● Utilize your resources, including other pharmacists and technicians ● Educate others – the more people are aware of the problem, the more people available to fix it
- 37. ● Vijay S,Ramasubramanian V, Bansal N, Ohri VC, Walia K. Hospital-based antimicrobial stewardship, India. Bulletin of the World Health Organization. 2023 ● MOHP, WHO. "Egypt National Action Plan For Antimicrobial Resistance." Fed. Minist. Agric. Environ. Heal 136 (2022): 66. ● Ruiz-Ramos, J.; Escolà-Vergé, L.; Monje-López, et al., The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department. Antibiotics 2023, 12, 1522. ● https://www.cdc.gov/antibiotic-use/graphics.html. ● Chandy SJ, Michael JS, Veeraraghavan B, et al., ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC). Indian J Med Res. 2014 Feb;139(2):226-30. ● Antimicrobial stewardship programmes in health-care facilities in low-and middle-income countries: a WHO practical toolkit ● Core Elements for Hospital Antibiotic Stewardship Programs: 2019 ● Alansary A. Antimicrobial Stewardship Program: Egyptian experience. QJM: An International Journal of Medicine. 2018 Dec:hcy200-059. ● Dr Nermin Hassan Ibrahim ppt presentation (Antimicrobial Resistance)
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