Clinical Microbiology

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  • Created by: LBCW0502
  • Created on: 29-11-19 09:13
Why do we need to optimise antimicrobial usage? (1)
Overuse of antimicrobials drives resistance. Use of inappropriate antimicrobials leads to worse clinical outcome. Inappropriate use of combination antimicrobial therapy can lead to no better outcome, increased ADRs and increased costs
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Why do we need to optimise antimicrobial usage? (2)
Delays in administration of antimicrobials can lead to worse clinical outcomes. Inappropriate dosing of antimicrobials can lead to worse clinical outcomes. Excessive duration of antimicrobial use leads to resistance, HCAIs and increased costs
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Why do we need to optimise antimicrobial usage? (3)
Increased antibiotic use, increase in pressure, change in population of organisms/flora (selective pressure), drives resistance. Inappropriate use of antimicrobials – e.g. too many, wrong antibiotic, broad-spectrum antibiotic, drug too active
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Why do we need to optimise antimicrobial usage? (4)
Need to consider patient factors, choice of antibiotic, drug factors. Combinations of antibiotics used – due to not identifying the exact organism/cause of infection
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Why do we need to optimise antimicrobial usage? (5)
Symptoms could be due to underlying condition, may not be directly linked to infection (or symptoms of different types of infections, non-specific e.g. fever). Treat infection immediately – better outcome in patient (e.g. sepsis - in 60 mins)
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How can antimicrobial usage be controlled to reverse trends in resistance? (1)
Antimicrobial stewardship. National and local guidelines. CQUIN. Targets. • Health and Social Care – legal requirement to practice antimicrobial stewardship
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How can antimicrobial usage be controlled to reverse trends in resistance? (2)
NICE guidance – antimicrobial stewardship – framework for practice, systems and processes, which specialities should be involved, structure and function of programme. Evaluate local guidelines, recent/current/link with practice
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What are the selected recommendations? (1)
Improve medical CPD on antimicrobial prescribing and usage. Government must do more to educate public. GMC and Royal Colleges should review undergraduate curricula. Industry should work to develop more rapid diagnostics
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What are the selected recommendations? (2)
Course length for antibiotics should be better defined. NHS needs better IT, especially in hospitals. Government should work with Pharma to develop incentives for new antimicrobials. Develop a strategy with targets and hold the NHS to targets, DOH
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What are the main purposes of the Code of Practice on prevention and control of infections and related guidance (Health and Social Care Act 2008)? (1)
Make registration requirements relating to infection prevention, clear registered providers so they understand what they need to do to comply. Provide guidance for CQC staff to make judgement on compliance with requirements for infection prevention
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What are the main purposes of the Code of Practice on prevention and control of infections and related guidance (Health and Social Care Act 2008)? (2)
Provide information for people who use services of a registered provider. Provide information for commissioners of services on what they should expect of their providers and provide information to the general public
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Describe features of the NICE guidance for antimicrobial stewardship (1)
Provides good practice recommendations on systems and processes for effective use of antimicrobials. Monitor/evaluate antimicrobial prescribing, produce/review guidance. Study link between prescribing/resistance
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Describe features of the NICE guidance for antimicrobial stewardship (2)
Provide regular feedback (annually) on prescribing habits (individual prescribers), patient safety incidents (e.g. HCAIs, ADRs, CDI), provide E&T on stewardship/resistance, integrate audit into existing QI programmes
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Describe features of the NICE guidance for antimicrobial stewardship (3)
Determine standards for treatment of infection – carry out studies on patients e.g. UTI, look at prescribing, diagnostic tests etc. Cross-link patient history (previous use of antibiotics) with resistance trends to determine chance of resistance
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What are the NICE quality standards? (1)
People with self-limiting condition assessed in primary care should receive self-management not antimicrobials. Prescribers in primary care can use a delayed prescription
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What are the NICE quality standards? (2)
People prescribed an antimicrobial have the clinical indication, dose, duration of treatment on clinical record. People in hospital prescribed an antimicrobial have a microbiological sample taken (treatment reviewed after results)
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What are the NICE quality standards? (3)
Those responsible for antimicrobial stewardship monitor data, provide feedback to prescribers, organisation. Prescribers in secondary care and dental care use EPS to link indication with antimicrobial prescription
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What is a delayed prescription?
Dated 7 days after consultation – e.g. chest infection, if it has not cleared up, suspect that chest infection is caused by bacteria, get prescription for antibiotic, useful tactic, not sure how widely it is used
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Why do we need incentives?
Increase in resistance of MRSA, C. difficile, E.coli and increase in antimicrobial consumption
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What were the incentives? (1)
Organisations given targets to reduce the number of cases involving resistance (consequence - receive a fine). Some issues included not isolating patients properly, various antibiotics banned (4Cs for C. difficile)
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What were the incentives? (2)
Able to control some factors in secondary care (not able to control external factors in primary care). Difficult to share data between primary and secondary care
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Describe features of CQUINs (1)
Commissioning for Quality and Innovation. Provides financial incentives for organisation to take up best practice. Range of conditions/areas covered. AMR and antimicrobial consumption included. Need to reduce by 1% from baseline
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Describe features of CQUINs (2)
Total antibacterial consumption. Carbapenem consumption. Piperacillin-taxobactam consumption. Also need to show performance of review therapy at 72h. Sepsis
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Describe features of quality premium in primary care (1)
Rewards CCGs for improvements in quality of services they commission. Also incentive improvements in patient outcomes and reduction in health inequalities. Focus on reduction of inappropriate antibiotic use
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Describe features of quality premium in primary care (2)
Reduce broad-spectrum antibiotics in primary care e.g. co-amoxiclav, ciprofloxacin, cephalosporins. Focus on reducing risk of infection associated with UTI, improve UTI management, reduce empirical first choice use of trimethoprim for lower UTI
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Describe features of quality premium in primary care (3)
Reduce use of trimethoprim in people aged 70 years or above
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Describe features of quality premium - management of UTIs (1)
Intended to improve management of UTI in people aged >70 years (greater risk of resistant infection, increased risk of empirical treatment failure/bloodstream infections). Reduce trimethoprim prescribing. Nitrofurantoin for UTI increased
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Describe features of quality premium - management of UTIs (2)
Need better management of urinary catheters, reduce Gram negative bloodstream infections (e.g. E.coli). There was a change in antibiotics but no change in numbers/outcome
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Why do we need to optimise antimicrobial usage? (2)

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Delays in administration of antimicrobials can lead to worse clinical outcomes. Inappropriate dosing of antimicrobials can lead to worse clinical outcomes. Excessive duration of antimicrobial use leads to resistance, HCAIs and increased costs

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Why do we need to optimise antimicrobial usage? (3)

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Card 4

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Why do we need to optimise antimicrobial usage? (4)

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Card 5

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Why do we need to optimise antimicrobial usage? (5)

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