Elements of Antimicrobial Stewardship
A coordinated strategy to optimize the use of antimicrobials with the goal of improving patient outcomes, reducing microbial resistance, and decreasing the spread of infections
What is "Antimicrobial Stewardship?"
You have a culture that tests positive for the penicillin binding protein 2A (PBP2A). What is the most likely microorganism growing on your culture?
What is "methicillin-resistant Staphylococcus aureus (MRSA)?"
This term describes the lowest concentration where an antibiotic can completely inhibit the growth of a microorganism in vitro.
What is the "Minimum Inhibitory Concentration (MIC)?"
This term describes the red, diffuse rash appearing on the trunk during or after rapid infusion of vancomycin.
What is "Red Man Syndrome?"
NOT a true vancomycin allergy! Slow down infusion and give premedication such a diphenhydramine
Treponema pallidum
What is "bacteria?"
Spirochaete bacterium with various subspecies that cause the diseases syphilis, bejel, and yaws. It is transmitted only amongst humans
The process of narrowing the spectrum and/or number of anitmicrobial agents based on clinical and microbiological culture results to limit adverse events, emergence of resistance, and preserve effectiveness of anitmicrobial agents
What is "antimicrobial de-escalation?"
You receive a page that a patient's blood culture isolated an ESBL (extended spectrum beta-lactamase) producing organism. What is the treatment of choice for this infection?
What is "carbapenems?"
This term describes the time course of drug absorption, bioavailability, distribution, metabolism, and excretion.
What is "pharmacokinetics?"
Concomitant administration of vancomycin and piperacillin-tazobactam increases this risk for this adverse effect.
What is "nephrotoxicity?"
Anteoculatia
What is "spell?"
Causes the target to grow antlers (caused Pansy Parkinson to grow antlers!)
The process of evaluating the continuing need and choice of antimicrobial therapy after 48-72 hours when the clinical picture is clearer and more diagnostic information is available
What is an "antimicrobial time out?"
What organisms have the highest risk for emergent resistance and clinical failure due to inducible AmpC beta-lactamases?
What is "Enterobacter cloacae and Enterobacter aerogenes?"
Zosyn and Cefepime are the drugs of choice for Ampc beta lactamases. Third generation cephalosporins are susceptible to inducible resistance.
The goal of this antibiotic directed killing is to maximize serum concentrations. Name an antibiotic that exhibits this this type of killing.
What is "concentration-dependent killing?"
What is "aminoglycosides, fluroquinolones, daptomycin?"
Use of antibiotics is the number one risk factor for this infection.
What is Clostridioides difficile infection?
Formerly known as Clostridium difficile
Inquilinus limosus
What is "bacteria?"
Novel gram-negative bacterium of the subdivision Proteobacteria. First isolated from cystic fibrosis patients' lungs, and is rarely observed elsewhere
An overall profile of antimicrobial susceptibility of local bacterial isolates to help guide appropriate empiric therapy
What is an "antibiogram?"
You have a patient on TPN growing Candida krusei from his PICC line. He has received fluconazole for Candida albicans UTI 4 weeks ago. What antifungal would you empirically choose for this patient?
What is "micafungin?"
The goal of this antibiotic directed killing is to have serum concentrations remain above the MIC for at least 50% of the dosing interval (t>MIC). Name an antibiotic that exhibits this this type of killing.
What is "time-dependent killing?"
beta-lactams (penicillins, cephalosporins, carbapenems, monobactams), clindamycin, macrolides (erythromycin, clarithromycin), oxazolidinones (linezolid)
What is "serotonin syndrome?"
Brucella abortus
What is a "bacteria?"
Brucella abortus is a gram-negative alpha-proteobacterium in the family Brucellaceae and is one of the causative agents of brucellosis. The prokaryotic B. abortus is rod-shaped non-spore-forming, non-motile, and aerobic.
Prescribing behavior is a complex, multifactorial process, including adherence to local culture and etiquette. ASP teams rely on (name one) these strategies to change behavior.
What is "education, audit and feedback, formulary restrictions, OR prior approvals?"
Enterococcus faecium is intrinsically more antibiotic resistant than Enterococcus faecalis for this resistance pattern.
What is "vancomycin resistant Enterococcus (VRE)?"
Achievement of a 24 hour AUC/MIC ratio of 400 and 600 mg*hr/L significantly reduces mortality when this antibiotic is used to treat susceptible infections.
What is "vancomycin?"
This term describes the breakdown of muscle fibers resulting in severe pain secondary to the use of daptomycin.
What is "rhabdomyolysis?"
Aparecium
What is "spell?"
Reveals secret messages written in invisible ink, or any other hidden markings. Also works against Concealing charms. Used by Hermione Granger to attempt to reveal any hidden writing in a diary.