Antimicrobial Stewardship What’s In It For YOU!

1. Antimicrobial StewardshipWhat’s In It For YOU! Paul Pottinger, MD, DTM&H Director, UWMC Antimicrobial Stewardship Program February 11, 2014

2. Show of Hands… Have you ever taken antibiotics? Whose life was saved by antibiotics?

3. Harsh Realities in USA • Abx for Humans: • Abx Courses / yr: • Abx for Outpatients: • Abx Appropriate: • 20% • > 300 mil • 50% • 50%

4. An Inconvenient Truth?

5. Brutal Truths • Abx Resistance is on the rise (and it’s our fault). • Abx discovery pipeline is all but dry. • We must control our destiny.

6. Physicians are not happy about any of this. “How should medical science respond?”

7. Key Players Must Respond! • Public Policy Makers

8. Key Players Must Respond! • Public Policy Makers GAIN act now law!

9. Key Players Must Respond! • Public Policy Makers

10. Key Players Must Respond! • Public Policy Makers • Researchers New Medications… and Beyond!

11. The Future: Pro-Biotics? • Lactobacillus crispatusis normal vaginal flora, drives down pH, keeps E.coli at bay. • Phase 2 trial of Lactin-V (Ocel) Suppositories (daily x 5, then weekly x 10) Stapleton CID 2011

12. Immunizations for Bad Bugs? • Limitation: Normal Flora  Pathogen. • May still be feasible versus high-profile non-symbionts.

14. Study Limitations • Animal model. • Limited repertoire of Staph isolates. • PNA examined, not SSTI or BSI. • Potential of MRSA Vaccine • Extraordinary potential benefits… Unanticipated consequences?

15. Key Players Must Respond! • Public Policy Makers • Researchers • Clinicians

17. Clinical Infectious Diseases 2013;57(5):631–8

18. Abx Training at UW, JHU, Miami • 4th - Year MD students surveyed several weeks before graduation… • Education Good / Very Good: 30-60% • Basic ID case scenarios: 51% correct • Information sources: Huge diversity (textbooks, manuals, peers, attendings, UTD, Wikipedia…) • Heard of Abx Stewardship: 40% • WE CAN DO BETTER!

19. What’s in a Name? “Antimicrobial Control”

20. What’s in a Name? “Antimicrobial Control” “Antimicrobial Management”

21. What’s in a Name? “Antimicrobial Control” “Antimicrobial Management” “Antimicrobial Stewardship” Stew·ard (noun): A person whose responsibility it is to take care of something.

25. “Spiraling Empiricism”

27. Campaign to Prevent Antimicrobial Resistance in Healthcare Settings 12 Break the chain 11 Isolate the pathogen 10 Stop treatment when cured 9 Know how to say no to vanco 8 Treat infection, not colonization 7 Treat infection, not contamination 6 Use local data 5 Practice antimicrobial control 4 Access the experts 3 Target the pathogen 2 Get the catheters out 1 Vaccinate Prevent Xmission Use Abx Wisely Dx & Rx Effectively Prevent Infections 12 Steps to Prevent Antimicrobial Resistance:Hospitalized Adults

28. Newer, Fancier, Pricier ≠ Better! Linezolid TMP/SMX For MRSA SSTI….

29. Pottinger’s Axiom: Time + Tube = Trouble CABSI VAP CAUTI

31. Prevent Infection • “Clean Your *&^%@! Hands” • Hand Hygiene Remains Cornerstone of IC • Biggest Cost:Benefit Ratio Around • Patients Will Thank (or Chastise) You! • Obey Precaution Placards IgnacSemmelweis (1818-65)

33. Key Players Must Respond! • Public Policy Makers • Researchers • Clinicians • Patients

34. If you’re not angry—or alarmed—you have not been paying attention. “What can I DO?”

35. I WANT YOU… To help bring antibiotic use under control! P2

36. Become an antibiotic steward! P2

37. Take Care of Each Other!

40. Abx Stewardship: Conclusions • “Our vs. Their Genes” • Few new abx coming… • Abx resistance is our fault… • Fixing this is our responsibility… • Respect needs & patterns globally • Together, we can do it! Brains THANK YOU