1 / 21

Bug Squad 101 and O ther A ntibiotic Pearls

Bug Squad 101 and O ther A ntibiotic Pearls. Chelsea Mannebach September 21 st , 2011. Objectives. Explain the purpose and goals of Bug Squad Discuss the importance of appropriate antimicrobial utilization Describe clinical pearls relating to antibiotic administration. Audience Poll.

cachet
Download Presentation

Bug Squad 101 and O ther A ntibiotic Pearls

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bug Squad 101 and Other Antibiotic Pearls Chelsea Mannebach September 21st, 2011

  2. Objectives • Explain the purpose and goals of Bug Squad • Discuss the importance of appropriate antimicrobial utilization • Describe clinical pearls relating to antibiotic administration

  3. Audience Poll • What do you know about Bug Squad? • (Have you ever heard about Bug Squad?)

  4. Bug Squad • Multidisciplinary team • Microbiology • Infection prevention • Medicine • Pharmacy • Twice weekly meetings • Goal • Antimicrobial stewardship/appropriate antimicrobial utilization

  5. Audience Poll • Why target antimicrobials?

  6. Issues • 10-30% of the average hospital pharmacy budget is spent on antimicrobials • Up to 50% of antibiotic use in hospitals is estimated to be inappropriate • Increasing rate of bacterial resistance thought to be in part due to antibiotic use • Improvements in antimicrobial use has been shown to improve patient outcomes and reduce resistance rates • Decreased number of antimicrobial drugs in pipeline From “Antimicrobial Stewardship,” Jamie Winner. Management of Infectious Diseases 32nd Annual Madison Clinical Conference. March 30, 2011.

  7. Audience Poll • What is antimicrobial stewardship?

  8. Antimicrobial Stewardship Goals • Optimize patient outcomes through improved antimicrobial utilization • Efficacy • Toxicity • Resistance • Reduce health care costs without adversely impacting quality of care • Length of stay • Drug cost From “Antimicrobial Stewardship,” Jamie Winner. Management of Infectious Diseases 32nd Annual Madison Clinical Conference. March 30, 2011.

  9. Microbiology • Culture information • Latest reports help guide de-escalation and appropriate antibiotic selection • Insight • Resistance Data • Antibiogram • Problem Bugs • MRSA (Methicillin Resistant Staphylococcus Aureus) • ESBLs (Extended Spectrum Beta Lactamases) • VRE (Vancomycin Resistant Enterococci) • KPCs (KlebsiellaPneumoniaeCarbapenemases) • C. difficile

  10. Audience Poll • Why de-escalate?

  11. De-escalation • Reduces selection pressure responsible for antimicrobial resistance by decreasing antimicrobial exposure • Contains costs • Reduces the risk of adverse events From “Antimicrobial Stewardship,” Jamie Winner. Management of Infectious Diseases 32nd Annual Madison Clinical Conference. March 30, 2011.

  12. Antibiogram • Susceptibility rates • Minimum Inhibitory Concentration (MIC) breakpoints • Dosing information • Cost data

  13. Infection Prevention • Isolation requirements • MRSA • c. difficile • ESBLs • Viruses (roto, RSV, influenza) • Meningitis (neisseria) • Sepsis Campaign • Protocols • Criteria • Mortality rate • Public Health • VAP • Ventilator-associated pneumonia • CAUTI • Catheter-associated UTI • CLABSI • Central line-associated blood stream infection

  14. Medicine • Dr. Gray • pathology • Dr. Skeem • internists • Dr. Workman • surgery

  15. Pharmacy • Selection and streamlining • Dose optimization • Patient characteristics • renal function, age, weight • Site of infection • meningitis, neutropenic fever, pneumonia • Pharmacokinetics • monitoring levels • IV to PO Conversion From “Antimicrobial Stewardship,” Jamie Winner. Management of Infectious Diseases 32nd Annual Madison Clinical Conference. March 30, 2011.

  16. Outcome Measurements • Microbiologic • Susceptibilities and resistance • Number of infections due to specific organisms • Clinical • Adverse drug events • Mortality • Clinical cure • Length of stay • Readmission rates • Financial • Cost savings From “Antimicrobial Stewardship,” Jamie Winner. Management of Infectious Diseases 32nd Annual Madison Clinical Conference. March 30, 2011.

  17. Antibiotic Clinical Pearls • Sepsis • Source control • Timeliness • Pharmacokinetics • Therapeutic window • Monitoring levels • Time dependent vs. concentration dependent

  18. Sepsis • 50-70% mortality • Mortality increases 7-10% every hour if not treated with goal-directed care • Sepsis Campaign (started 2002) • Reduce mortality to 25% • Goal-directed therapy • Reperfusion • Labs and cultures • Source control • Antibiotics Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. 2004 (revised 2008 Jan). NGC:006316. Society of Critical Care Medicine

  19. Pharmacokinetics • Time-dependent Antibiotics • Vancomycin • B-lactams • Concentration-dependent Antibiotics • Fluoroquinolones • Aminoglycosides

  20. Summary • Dry pipeline, we are stuck with what we have • Bugs are smart • Essential that we protect our patients and our antimicrobials • Nursing plays an important role in ensuring appropriate and timely antimicrobial administration

  21. Questions?

More Related