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Pillars of Infection Management
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The goal of antimicrobial stewardship is to ensure appropriate use of antimicrobial agents, improve patient outcome and reduce risk of both adverse drug events and emergence of antimicrobial resistance. Safety and effectiveness of antimicrobials including glycopeptides, aminoglycosides and certain azoles require therapeutic drug monitoring to ensure adequate blood levels.
Long-Term Care Pharmacy
Published in William N. Kelly, Pharmacy, 2018
The never-ending march of antimicrobial resistance is a major threat to worldwide health. Fortunately, there is a strategy to slow down, and in some instances, reduce antimicrobial resistance. Antimicrobial stewardship is a systematic approach to the use of antimicrobial agents to achieve optimal outcomes, as close to 100% of the time as possible. This means using the correct agent, at the correct dose, with the correct route of administration, and for the appropriate duration, to cure or prevent infection, while minimizing toxicity and emerging resistance.35,36
The Pharmacist Role in Antimicrobial Stewardship and Interpreting Microbiology Laboratory Results
Published in Nancy Khardori, Bench to Bedside, 2018
Stephanie Crosby, Mark DeAngelo, Nancy Khardori
With the field of pharmacy becoming more involved in clinical aspects of patient care, especially in hospitals and other healthcare institutions, many organizations are utilizing pharmacists as a part of multidisciplinary teams, including antimicrobial stewardship programs. According to the Infectious Disease Society of America (IDSA), antimicrobial stewardship should focus on optimizing patient outcomes while limiting antimicrobial use to prevent toxicity and development of resistance (Delit et al. 2007). The antimicrobial stewardship program should include both infectious- disease trained physicians and pharmacists as the core of the team, with other participants including microbiologists, infection control specialists, informatics and epidemiologists if available (Patel and MacDougall 2010).
Empirical antimicrobial therapy for bloodstream infections not compliant with guideline was associated with discordant therapy, which predicted poorer outcome even in a low resistance environment
Published in Infectious Diseases, 2022
Kornelius Grøv, Erling Håland, Bjørn Waagsbø, Øyvind Salvesen, Jan Kristian Damås, Jan Egil Afset
In conclusion, this study showed that empirical antimicrobial therapy for BSI is more concordant with AST reports if such therapy is in accordance with national clinical practice guideline recommendations. The case fatality rate was significantly higher for BSI episodes that received discordant therapy. In this study, we disclosed predictors for discordant antimicrobial therapy. Antimicrobial stewardship programmes in general encourage health professionals and authorities to assess predictors for discordant empirical antimicrobial therapy carefully and implement antimicrobial stewardship measures to facilitate therapy prescribing. Measures should include strategies that target prompt identification and AST, guideline-based initiation of therapy, and compulsory early therapy assessments. Regardless of AMR prevalence, we encourage others to investigate concordant antimicrobial therapy in order to secure rigorous clinical guideline recommendations.
A profile of the binx health io® molecular point-of-care test for chlamydia and gonorrhea in women and men
Published in Expert Review of Molecular Diagnostics, 2021
Barbara Van Der Pol, Charlotte A. Gaydos
The binx io CT/NG assay is the first molecular POC assay with sufficiently short running time to have the potential for significantly impacting STI control practice. The test is simple enough that it was performed almost exclusively by non-laboratorians, including nurses and administrative staff, during the multi-site US clinical trial. The assay has recently received CLIA-waived status, which provides US regulatory approval for use by non-laboratorians. By adapting to a sample-first specimen collection process where the testing can begin immediately following registration, the results may, in many settings, be available to the health care provider prior to patient interactions thus facilitating a discussion about the meaning of the results, as well as making accurate treatment decisions possible before the patients leave the clinic. Managing use of antimicrobials rather than relying on epidemiologic factors and clinical observations is an important strategy in antimicrobial stewardship efforts.
Experience of Ceftazidime/avibactam in a UK tertiary cardiopulmonary specialist center
Published in Expert Review of Anti-infective Therapy, 2021
Lisa Nwankwo, Zahraa Butt, Silke Schelenz
Our study highlights the importance of Antimicrobial stewardship in ensuring new and expensive antimicrobials are used in the right cohort of patients and with the right guidance. The Antimicrobial stewardship teams require adequate IT solutions to recognize antibiotic usage that demonstrate deviations from local guidelines, and facilitate support in a timely manner. The need for appropriate cultures prior to starting an antibiotic is evident and both susceptibility testing and clinical response should guide continuation of therapy. Education to clinical teams prescribing recently licensed antimicrobials should be a component of the support offered by the Antimicrobial stewardship teams. It is important to review all antibiotics at 48–72 hours as per the Start Smart-then focus initiative [20], again to limit the development of antimicrobial resistance via selection pressure and to protect the utility of these new antimicrobial agents. Ceftazidime/avibactam remains an option in the treatment of MDR bacterial infections with limited treatment options. Newly approved antibiotic agents should not be used as first line empirical therapy, and each hospital should consider addition to their own local formulary after careful consideration of their own patient cohorts, with review of the literature, and local susceptibility patterns.