General Knowledge
What is the cost for complications associated with antimicrobial resistance in Canada?
a) 1 billion dollars
b) 100 million dollars
c) 10 million dollars
What is the cost for complications associated with antimicrobial resistance in Canada?
ans. 1 billion dollars
How many people are killed each year in Canada due to resistant organisms?
a) 1000
b) 2000
c) 3000
d) 4000
How many people are killed each year in Canada due to resistant organisms?
ans. 2000
What is the name of the AHS drug app that can assist in better prescribing practices based on susceptibility/resistance?
What is the name of the AHS drug app that can assist in better prescribing practices based on susceptibility/resistance?
ans. Bugs and Drugs
Which is the most common pathogen listed below implicated in bacterial meningitis in infants less than 6 weeks old?
a) Group B streptococcus
b) Neisseria meningitidis
c) Streptococcus pneumonia
d) H. influenza
Which is the most common pathogen listed below implicated in bacterial meningitis in infants less than 6 weeks old?
ans. Group B streptococcus
What % of antibiotic use is inappropriate?
a) 30%
b) 40%
c) 50%
d) 60%
What % of antibiotic use is inappropriate?
ans. 50%
What are two unintended consequences of antimicrobial use?
Selection of pathogenic organisms (eg. C. difficile)
Increased antibiotic resistance (patient and population level)
Antibiotic adverse effects/toxicities
Increased health care costs
How long ago was the last new class of antibiotics created?
a) Within the last 3 years
b) Within the last 3-10 years
c) Within the last 10-20 years
d) More than 20 years ago
How long ago was the last new class of antibiotics created?
ans. More than 20 years ago. Some sources are showing 1984, some showing 1987. Basically a long time ago
A physician calls you for your advice at your pharmacy. He has heard about post-intercourse prophylaxis for the management of recurrent acute uncomplicated urinary tract infections. Which of the following regimens is wrong?
a) Sulfamethoxazole-trimethoprim 200mg/40mg one dose after sexual intercouse
b) Nitrofurantoin 50 mg one dose after sexual intercourse
c) It is not recommended to give one dose of antibiotics for the management of recurrent UTIs after sexual intercourse
d) Norfloxacin 200 mg one dose after sexual intercourse
Which of the following regimens is wrong?
ans. It is not recommended to give one dose of antibiotics for the management of recurrent UTIs after sexual intercourse
What was the provincial-wide compliance with hand hygiene in 2017/2018?
Bonus: Which healthcare profession is best at hand hygiene? (100pts)
What was the provincial-wide compliance with hand hygiene in 2017/2018?
ans. 85%
Bonus: Which healthcare profession is best at hand hygiene?
ans: Nurses
What is an antibiogram?
What is an antibiogram?
ans. The hospital antibiogram is a periodic summary of antimicrobial susceptibilities of local bacterial isolates submitted to the hospital's clinical microbiology laboratory.
What percentage of medically important antibiotics are sold for use in animal agriculture in the US (2015 Data)?
What percentage of medically important antibiotics are sold for use in animal agriculture in the US (2015 Data)?
ans. 70% (Guess within 5% on either side)
Alice goes to see her family physician upon your suggestion of a urinary tract infection. She comes back to your pharmacy with a new prescription. The prescription reads: Trimethoprim-sulfamethoxazole DS (double strength) 1 tablet BID for 3 days. What are the advantages of trimethoprim-sulfamethoxazole combination?
a) Highly effective against most aerobic enteric bacteria
b) High urinary tract levels
c) High urine levels
d) Effective as prophylaxis for recurrent infections.
What are the advantages of trimethoprim-sulfamethoxazole combination?
ans. Highly effective against most aerobic enteric bacteria
Approximately what percentage of cough is viral with or without sputum?
Approximately what percentage of cough is viral with or without sputum?
ans. 90% (+/- 5% is acceptable)
What is antimicrobial stewardship?
Coordinated interdisciplinaryinterventions designed to promote optimal antimicrobial use through optimizing selection, dose, duration and route.
Goals (optional)
•Optimize patient clinical outcomes
•Minimize toxicity/adverse events
•Minimize the selection of pathogenic organisms (eg.C. difficile)
•Decrease or at least stabilize antibiotic resistance
•Reduce unnecessary health care costs
A patient comes to see you with a sore throat. Your clinical exam is very suspicious for strep throat and you decide to prescribe penicillin. Your patient says: “No doc, I have a penicillin allergy so you have to prescribe a broad-spectrum antibiotic instead!” What do you do first (Pick the best answer)?
a) Prescribe something else like a cephalosporin
b) You don’t know it’s strep so you should swab before writing a prescription anyway
c) Ask about their allergy symptoms
ans. Ask about their allergy symptoms
*Teaching point: 10% of people claim they’re allergic to penicillin but in reality less than 1% of the population is truly allergic. This forces docs to prescribe more broad-spectrum antibiotics ($$$ + resistance) so always ask about allergy symptoms to find out if it’s a true allergy or just an intolerance! Most people outgrow their penicillin allergy with 10 years too!
Which antibiotic would you use for this organism?
None, it is a virus --> Ebola
Name the SPICE (or SPACE) organisms (these bacteria contain AmpC chromosomal beta-lactamases; genera for each is sufficient).
S = Serratia spp.
P = Pseudomonas aeruginosa or Providencia spp
I = Indole-positive Proteus spp.
C = Citrobacter spp.
E = Enterobacter spp.
The “A” in SPACE stands for Acinetobacter spp.
What are 3 strategies that could be used to promote antibiotic awareness?
Providing clear guidelines on when more broad spectrum antibiotics should be prescribed - keeping these up to date and easily accessible to doctors
Have secondary forms/approval for prescribing broad spectrum antibiotics
Public education when antibiotics are required. And about proper use and disposal of antibiotics
From the Antimicrobial Stewardship Program toolkit of interventions
1. Restriction and pre-authorization
2. Prospective audit and feedback
3. Education
4. Clinical Practice Guidelines and Pathways
5. Streamlining/De-escalation
6. Dose optimization
7. Intravenous to Oral conversion
8. Microbiology Laboratory
-> #1 and #2 are most effective
Name 3 mechanisms of antibiotic resistance.
Enzymatic inhibition
Decreased permeability of bacterial membranes
Promotion of antibiotic efflux
Altered target sites
Alteration of cell wall precursor targets
Alteration of target enzymes
A 44 year old woman comes to the Emergency Department with a 2-day history of fevers, rigors, dysuria, and right >>> left flank pain. Her urinalysis shows pyuria. Blood and urine cultures are pending. She claims an allergy to pencillin: it was 10 years earlier, the medication was for a sore throat and was three times daily (?amoxicillin?), and she developed hives/throat swelling/ difficulty breathing, requiring an emergency department visit.
Which of the following is most true:
a) She can be safely given ceftriaxone, to treat a pyelonephritis.
b) She can be safely given vancomycin to treat a pyelonephritis.
c) She can be safely given piperacillin-tazobactam to treat a pyelonephritis.
d) She does not require empiric antimicrobial therapy - treatment should be withheld until culture results are available.
ans. She can be safely given ceftriaxone, to treat a pyelonephritis.
She can be safely given vancomycin to treat a pyelonephritis - vancomycin only covers Gram (+) organisms, but kidney infections are most likely caused by Gram (-) organisms
She can be safely given piperacillin-tazobactam to treat a pyelonephritis - she has had a previous severe allergic reaction to penicillin so cannot give her that, 80% of people get over their penicillin allergy in 10yrs but 20% of people do not.