AS1
About 10%of the population is labeled as penicillin allergic but only this percentage are truly allergic to penicillin.
What is <1% of the population?
This is the time frame for prospective auditing and feedback after an antibiotic is started.
What is 48 to72 hours?
An antibiogram is used in antimicrobial stewardship to select this kind of therapy for UTI guidelines.
What is empiric therapy?
A UTI treatment guideline should clearly discourage the use of antibiotics for this condition.
What is asymptomatic bacteriuria?
This is a common reason why 10% of people are labeled penicillin allergic but only <1% are actually allergic to penicillin (name one or more).
What is 1) penicillin allergy goes away over time or 2) the original penicillin reaction was a side effect mislabeled as an allergy?
Antibiotic stewardship actions: 1) prospectively review orders for ciprofloxacin to determine whether appropriate per treatment guidelines, 2) provide prescriber education (feedback) about increasing resistance to ciprofloxacin, 3) create or revise a facility UTI treatment guideline that addresses appropriate use of ciprofloxacin. These actions might be taken by an IP when this problem happens.
What is a significant increase in resistance to ciprofloxacin in the facility?
Selection of empiric treatment recommendations in a facility specific guideline should be effective versus these selected organisms, not all organisms.
What are the most common organisms isolated on the antibiogram?
These drugs are NOT recommended as first-line empiric therapy for most UTIs in long-term care and elderly patients due to bacterial resistance and risk of serious side effects
What are fluoroquinolones?
CDPH plans to expand the antimicrobial stewardship honor roll that recognizes facilities for fully implementing the CDC core elements to this additional healthcare setting
What are skilled nursing facilities?
Prospective audit and feedback typically involves recommending these two types of changes to empiric therapy (based on symptom improvement and lab/culture results)
What are discontinuation, and de-escalation (narrowing) therapy?
Facilities that practice prospective audit and feedback often pair feedback with this to reinforce long-term prescribing improvements
What is prescriber education?
Antibiograms should be updated this often.
What is annual (sometimes every 2 years for smaller facilities)?
Patients with a penicillin allergy label are more likely to experience these negative outcomes (name two or more).
What is 1) lower clinical cure rate, 2) increased side effects,3) increased bacterial resistance?
This facility data should be updated and reviewed to ensure facility specific UTI treatment guidelines remain up to date with current bacterial resistance trends.
What is the facility antibiogram?
Fluoroquinolones have been strongly linked to this serious antibiotic-associated infection, a major concern for outbreaks in long-term care facilities and hospitals.
What is Clostridioides difficile infection?
These antibiotic stewardship "process" measures should be tracked and reported (hint: think prospective audit and feedback). Name one or more
What are antibiotic stewardship interventions and prescriber acceptance rate?
This simple procedure can be done to remove a penicillin allergy label so long as the individual has a "low-risk" penicillin allergy.
What is an amoxicillin challenge?
UTI treatment guidelines should include this monitoring option that can help avoid over treatment of ASB.
What is a ‘watch and Wait’ protocol?
An IP can provide prescriber feedback and reinforce empiric UTI guidelines in response to this.
What is an antibiotic use report showing frequent use of ciprofloxacin for UTIs?
Thirty isolates per organism in an antibiogram is:
What is the minimum number of isolates needed to to include in the antibiogram?
Performing this is good way to assess whether an AS program is meeting all of the CDC core elements.
What is a gap analysis?
Tracking annual susceptibility rates for selected bug-drug combinations of interest (example: Pseudomonas aeruginosa or E.coli susceptibility to ciprofloxacin) can be used to show the impact of this.
What is antibiotic stewardship program actions?
Facility specific treatment guidelines should be audited periodically to ensure this.
What is prescriber adherence to empiric therapy recommendations?
Use of narrow spectrum antibiotics is preferred, when appropriate, because they help limit the selection of these dangerous organisms.
What are multidrug-resistant organisms (MDROs)?