Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Antimicrobial stewardship where`s the evidence?
Document related concepts
Transcript
Antimicrobial stewardship Mike Richards Kirsty Buising IT IS NOT ACCEPTABLE: 200,000 healthcare-associated infections (HAIs) in Australia annually 2 x 106 HAIs in USA annually 30 to 50% hospitalised patients receive antibiotics Up to half antimicrobial use is inappropriate International attention on increasing antimicrobial resistance White paper IDSA advocacy 2004 10x20 campaign – incentives for drug development Recognition as a public health issue “Antimicrobial resistance is a Public Health problem” WHO Global Patient Safety Challenge 2010 Tremendous variety in antibiotic consumption and antibiotic resistance in Europe Antibiotic consumption correlates with antibiotic resistance on national levels 2008 First antibiotic awareness day – 30 countries In our region…. Factors encouraging spread of Antimicrobial resistance In hospitals prolonged broad spectrum antibiotics use cross transmission of pathogens Belief that new, expensive drug are more efficacious than older Prescribers driven by patient expectations Poor patient compliance Self medication in some countries – choice, duration Veterinary use Tackling antimicrobial resistance Rational drug use Infection prevention Surveillance Research Animal husbandry What is antimicrobial stewardship? Optimal selection of drug Optimal dosage Optimal duration Best clinical outcome Minimal toxicity Minimal impact on resistance Antimicrobial stewardship Educate Restrict Guidelines – empiric and directed Access to information – micro sensitivities, dosing advice Formularies Approval systems pre and post prescription Audit and feedback Principles of antibiotic prescribing Antimicrobial stewardship Strategies: Phone approval Paper based approval forms Stewardship teams RMH Guidance team Investigating role of computerised decision support Software only one element- need antimicrobial committee, team, audit, feedback, education Local efforts: AAS RMH 2001 - addressed ceftriaxone use Reduced ceftriaxone consumption Local efforts – iMicro in ICU Access to information on sensitivies, prescribing advice More likely to cover the pathogen Less antibiotic consumption Reduced MDR gram negatives in ICU Yong JAC 2010 Guidance DS Guidance DS Less antibiotic consumption – several classes broad spectrum drugs Buising JAC 2008 Roll out to other hospitals….. Eastern Health St Vincents Health Guidance MS www.guidancems.org.au
