Antibiograms
An antibiogram is used in antimicrobial stewardship to select this.
What is optimal empiric therapy that is narrow in bacterial spectrum
The guideline should clearly distinguish between these two conditions to prevent unnecessary antibiotic use.
What is asymptomatic bacteriuria versus symptomatic infection
The recommended antibiotic duration for uncomplicated cystitis in skilled nursing facility residents is
What is 5 to 7 days.
These three gram-negative organisms are the most common causes of urinary tract infections in both the community and nursing home residents
What is E.coli (highest - 70%), Klebsiella pneumoniae and Proteus mirabilis
Prospective audit and feedback (review of patient symptoms, progress and culture/lab results) is done in this time frame after an antibiotic is started.
What is 48 to 72 hours
An infection preventionist notices that E. coli resistance to ciprofloxacin is 35% in their facility. According to stewardship principles, this means…
What is ciprofloxacin should not be used empirically for UTIs likely to be caused by E. coli.
To reduce antibiotic resistance, guidelines should generally, emphasize using this type of antibiotic for which length of time whenever possible
What is the narrowest spectrum agent for the shortest duration possible
Fluoroquinolones are not recommended as first-line empiric therapy for uncomplicated UTIs in nursing home residents because of these two key reasons
What is increasing bacterial resistance and risk of serious side effects
This non-lactose-fermenting Gram-negative organism that causes urinary tract infections is associated with multidrug resistance (only ciprofloxacin works)
What is Pseudomonas aeruginosa
Prospective audit and feedback recommendations typically focus on these two key changes to empiric therapy based on symptom improvement and lab/culture results
What are discontinuation, or de-escalation, (or dose/duration adjustment)
The frequency at which a facility should update its antibiogram to ensure data reflect current resistance patterns.
What is at least annually
This process ensures guidelines remain up to date with current bacterial resistance trends.
What is an annual review and update based on the facility antibiogram, and antibiotic use or prescribing data
Fluoroquinolones have been strongly linked to this serious antibiotic-associated infection, a major concern in long-term care facilities.
What is Clostridioides difficile (C. diff) infection
This organism is a common cause of catheter-associated UTIs (CAUTIs)
What is Klebsiella pneumoniae?
Facilities using Prospective Audit and Feedback often pair feedback with this to reinforce long-term prescribing improvements.
What is prescriber education (usually about guidelines, or audit findings)
This key partner should collaborate with the infection preventionist when developing empiric therapy guidelines from antibiogram data
What is the facility’s antibiotic stewardship team pharmacist and/or physician.
Treatment guidelines should include this important option to reduce antibiotic overuse in patients who have low probability for having a UTI (no localized UTI symptoms).
What is an observation or ‘watchful waiting’ protocol.
These two oral beta-lactam (penicillin and related) antibiotics are considered useful (and narrower in spectrum of activity) treatment options for urinary tract infections in many skilled nursing facility residents
What are amoxicillin/clavulanate and cephalexin.
This group of bacteria, named for their extended resistance mechanisms, are becoming common in UTIs in skilled nursing facility residents and generally require IV therapy
What are ESBL-producing Enterobacterales?
An antibiotic stewardship log is an important tool for tracking and reporting to quality committees about the antibiotics reviewed, the type of interventions done and this
What is intervention acceptance rate by prescribers
The infection preventionist notices increasing Pseudomonas resistance in urine and wound cultures and collaborates with prescribers to change empiric coverage. This activity supports which CDC stewardship core element?
What is action — implementing interventions to improve antibiotic use.
Guidelines should be measured for this periodically by IPs (or CPs).
What is prescriber adherence to empiric therapy recommendations.
Beta-lactam antibiotics (amoxicillin/clavulanate and cephalexin) are preferable for UTIs because they may limit selection pressure for these dangerous organisms
What are multidrug-resistant organisms (MDROs)
True or false: Facility-specific empiric treatment recommendations for UTIs should be effective against all organisms isolated from urine cultures over the previous one year.
What is false. Empiric therapy should be directed against the most common organisms isolated in the previous year.
An antibiotic use report shows frequent use of ciprofloxacin for UTIs by some prescribers. The infection preventionist’s next step could be
What is provide prescriber feedback and reinforce empiric UTI guidelines