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Terms in this set (9)
1. carbapenem resistant enterococcus.
2. very few treatment options for this microbe
evidence for resistance
1. more resistance in HAI's
2. changes in Ab use modulate resistance: e.g use of carbapenems linked to CRE
-in fact, use of ANY antibiotic exposure in past 90 days is linked to increased CRE, ESBL.
3.each additional day on Ab even selects for resistance
effect of stewardship programs on Ab resistance
cut it in 1/2
why is Ab resistance important?
1. delays in treatment lead to poorer outcomes
2. use of inferior drugs: e.g B-lactams are more effective than Vanco, but Vanco covers MRSA.
3. forced to use more toxic drugs, e.g polymyxins
4. increase length of stay and mortality
resistance and stewardship
1. optimize outcomes for patients with multiple resistant drugs
2. decrease development of resistance.
Antimicrobial stewardship strategies
1. Active: audit, feedback, de-escalate therapy, formulary restriction
2. passive: education, guidelines, etc.
3. review culture results, optimize doses,
1. do appropriate tests
2. pick the appropriate empiric therapy
3. narrow down therapy down the line
4. know susceptibilities (use antibiograms)
when to streamline antibiotics
1. when causative organism is known
2. discontinue unnecessary drugs
-e.g Vanco when you know it isn't MRSA
-stop broad spectrum antimicrobials to prevent resistance development, C. Diff.
Duration of Therapy
1. decreases likelihood of resistance, C. diff.
2. decreases cost.
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