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prudentlyand Antibiotic
Stewardship
HENDRO WAHJONO
SM M!"RO#!O$O%! "$!N!"
RSU& DR "AR!AD!'()*
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Contents of this presentation
Antibiotic resistance + a patient sa,etyissue
Situation in !ndonesia
Dri-ers o, antibiotic resistance
.onse/uences o, antibioticresistance
Why inappropriate use o, antibiotics
contributes to antibiotic resistance +the 0why1
How prudent use o, antibiotics can bepro2oted in hospitals + the 0how1
Optimize Clinical Outcomes through appropriate
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WHO + World HealthDay World Health
Day is
celebratedevery year on7 April, under
thesponsorship ofthe World
Health Dr!"#ao $D %
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WARAGAINSTMICROBES
Theartofwarisdeception;thatisdeceivingthe
enemy.Butinthewaragainstmicrobeswehave
deceivedourselvesbymisusing,under-usingand
overusingantibiotics
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How do you deter2ine whichantibiotic to use3
.on4r2 presence o, in,ection
!denti,y the pathogen555Microbiology $ab5
Selecti-e e2piric therapy based onhost
and drug ,actors
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Outco2e o, the irst Su22it Meetings 6 '((7
Reco22endations ,or E2pirical 8herapy &no' your atient
"now your Drug
&no' your nviron*ent
&no' your +i*itations
Role o, the Microbiologist rovide an ecellent database of the prevalence -
susceptibility pro.les of *icroorganis*s in theCo**unity, Hospital - /C0
1e part of the /C0 tea*
AIM INDIA, 2003
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2 What3s the *ost epensive
4W antibiotics 5
A !he one that doesn3t
'or6
!
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8hin9 be,ore -Prescribing an antibiotic
Is an antibiotic necessary ?
What is the most appropriate
antibiotic ?What dose, frequency, route and
duration ? Is the treatment effective ?
Dr!"#ao $D 8
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T>MIC
Cmax/MICAminoglcosides
Fluoro!uinolones
A"C/MICAminoglcosides
Fluoro!uinolones
#inezolid
$aptomcin
Tetracclines
Concentration
MIC
Cmin%Trough
$osingisImportantConcentrationdependant
Cmax%'ea5
Time
dependant
'enicillins
Cephalosporins
Carbapenems
Macrolides
6ancomcin
Clindamcin
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How 8o .hoose Antibiotic:s;3
&A8!EN8
!n,ection8ype
M!.ROOR%AN!SM
&"
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#!O$O%!.A$
RES&ONSEMOD!!ERS
AN8!#!O8!.S
=
IMUNOMODULATO
R
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)5 AN8!#A.8ER!A$
A.8!>!8?
A.8ORS O !N >!>O EE.8
'5 &HARMA.O"!NE8!.S
@ H!%H.ON.EN8RA8!ON
!N #$OOD
@ H!%H &ENE8RA8!ON8O
8!SSUES
75 .OO&ERA8!>E A.8!>!8?
W!8H HOS8 DEEN.E
ME.HAN!SM
@ .OO&ERA8!>E A.8!>!8?
W!8H &HA%O.?8ES AND
.OM&$EMEN8S
8REA8MEN8 O!NE.8!ON
)5
'5
75
)5
'5
75
8!ME
AN8!#!O8!..ON.EN8RA8!ON!N 8!SSUES
M!.
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What is Anti*icrobial9te'ardship An interdisciplinary tea* dedicated
to practices that i*proveappropriate selection, dosing, route,
and duration of anti*icrobial therapy
!he ulti*ate goal of anti*icrobialste'ardship is to i*prove patient
care and health care outco*es
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Antibiotic 9te'ardship
De.nition: A syste* of infor*atics, datacollection, personnel, andpolicy;procedures 'hich pro*otes theopti*al selection, dosing, and duration of
therapy for anti*icrobial agents throughoutthe course of their use
urpose:
+i*it inappropriate and ecessiveantibiotic use
/*prove and opti*ize therapy andclinical outco*es for the individual
infected patient
Ohl CA Seminar Infect Control ?>:=Ohl CA, +uther " Hosp $ed >?B:9
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/s pertinent to inpatient, outpatient, andlong@ter* care settings
/s practiced at the +evel of the patient
+evel of a health@care facility or syste*, ornet'or6
9hould be a core function of the *edicalstaF
(ie doctors and other healthcareproviders)
0tilizes the epertise and eperience of
clinical phar*acists, *icrobiologists,infection control ractitioners and
Antibiotic 9te'ardship
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Anti*icrobial 9te'ardship!ea* /nfectious Disease
hysician
Clinical har*acist
Clinical*icrobiologist
/nfor*ation 9yste*9pecialist
/nfection controlprofessional
Hospitalepide*iologist
+eadership support .!D '((B CC :)@
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arly Appropriate Antibiotics and9ource Control
Gra* positive organis*s havesurpassed gra* negatives as the*ost co**on source of sepsis
!herapy targeted to the suspectedsite (eg, CA, intra@abdo*inalsource)
Drainage, debride*ent and devicere*oval as indicated
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Resistance equation
Risk of emergence antibiotic resistance
geneticselectionAntibioticpressure
7is5of
crossinfection
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Conversion fro* parenteral to oral therapy Having a syste*atic
plan for s'itching fro*parenteral to oraltreat*ent *ay have
an added bene.t ofaiding in early hospitaldischarge planning
Develop*ent ofclinical criteria and
guidelines allo'ingconversion canfacilitatei*ple*entation
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9o*e Health@Care Associated/nfections that $ay Occur
0!/ associated 'ith oley catheters
+o'er respiratory tract infection
(post@op and ventilator dependent) 96in necrosis (s6in brea6do'n)
1lood strea* infection (and line
associated) 9urgical@site infection
4utrition@related and *alnutrition
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!herapy Across the 9epsis Continuu*
Chest1992;1011!""#
SepsisS!RSSe-ereSepsis
SepticShoc9
Antibiotics and Source .ontrol
Chest>8(>):>B
B year or PB years
9urgical;invasive procedures
$alnutrition
0se of broad@spectru* antibiotics Chronic illness
D$
C# Hepatitis
/**unode.ciency disorders
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Nicki Roderman, RN, MSN, CCRN
#is6 actors
Co*pro*ised /**une 9tatus: A/D9
0se of cytotoic and
i**unosuppressive agents Alcoholis*
$alignant neoplas*s
!ransplant /ncrease in the nu*ber of drug@
resistant *icroorganis*s
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Nicki Roderman, RN, MSN, CCRN
&eys
&eys to success:
8i2ely co22unication and
,eedbac9Ongoing i2pro-e2ents
Data@dri-en approach
Regular co22unication o, results
)OLLABORATION0
Should this patient get appropriate treatment?
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Should this patient get appropriate treatment?
>< 9teps to revent Anti*icrobial #esistance: Hospitalized Adults
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/nfectious Diseases pert#esources
/nfectious Diseases9pecialists
Opti*alatient Care
Opti*alatient Care
/nfection Controlrofessionals
Healthcarepide*iologists
Clinicalhar*acists
Clinicalhar*acologists
9urgical /nfectionperts
Clinical$icrobiologists
Step 4: Access the experts
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Reliableanswers
$east possible
ris9
Rapid diagnosisAppropriate treat2ent
$icrobiology +ab
.linician
Co**unication
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GOA+9
>atient safety
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Wor6ing together creates 9afeHospitals
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8each Hand Washing a Habit toE-eryone
Dr!"#ao $D %
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Antibioticssave +ives9ave Antibioticsfro* $isuse
Dr!"#ao $D
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Docu*ent your Antibiotic #esistanceand 9ensitivity atterns 'ith WHONE8
WHO4! is a freesoft'are developed bythe WHO CollaboratingCentre for 9urveillance
of Anti*icrobial#esistance forlaboratory@basedsurveillance of
infectious diseasesand anti*icrobialresistance
Dr!"#ao $D
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%lobal United Eorts .anReduce Antibiotic Misuse
Dr!"#ao $D B
CONCLUSION
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CONCLUSION
$ccordin% to appropriate use %uide&ines it is important to
0se antibiotics only for bacterial infections
1etter *anage anti*icrobial resistance it is critical
0se targeted antibiotics 'ith appropriate@spectru*of activity and dose
/*prove co*pliance 'ith antibiotic regi*ens
'
.D. %et S2art &rogra26
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Discussed prescribing strategies - 'here toaccess help ; infor*ation
#esistant G(@) dan G(Q) should be 'ellconsidered
#eliable Clinical $icrobiology data supportthe decision
Antibiotic ste'ardship is i*portant for
preserving eisting antibiotics and
CONCLUSION
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TERIMA KASIH