Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Antimicrobial Stewardship in Thailand
Assistant Professor Kumthorn Malathum
Faculty of Medicine Ramathibodi Hospital,
Mahidol University, Thailand
1
Antimicrobial Stewardship: DefinitionAntimicrobial Stewardship: Definition
Coordinated interventions designed to improve
and measure the appropriate use of [antibiotic]
agents by promoting the selection of the optimal
[antibiotic] drug regimen including dosing[antibiotic] drug regimen including dosing,
duration of therapy, and route of administration
Barlam TF Et al CID; 2016;62(10):e51–e77
2
Barlam TF. Et al. CID; 2016;62(10):e51–e77
Antimicrobial Stewardship: BenefitAntimicrobial Stewardship: Benefit
Improved patient outcomes, Reduced adverse events
Improvement in rates of susceptibilities Improvement in rates of susceptibilities to targeted antibiotics
Optimization of resource utilization
Barlam TF Et al CID; 2016;62(10):e51–e77
3
Barlam TF. Et al. CID; 2016;62(10):e51–e77
RecommendationsRecommendations
Preauthorization and/or prospective audit and feedback interventionsinterventions
Interventions designed to reduce the use of antibiotics associated with a high risk of CDIassociated with a high risk of CDI
Dedicated pharmacokinetic (PK) monitoring and adjustment programadjustment program
Interventions to increase use of oral antibiotics Reduce antibiotic therapy to the shortest effective
duration
4Barlam TF. Et al. CID; 2016;62(10):e51–e77
Core element of ASPCore element of ASP
Leadership commitment – national, some h it lhospitals
Accountability and drug expertise Accountability and drug expertise Physician and pharmacist with formal training in
infectious diseases and/or antibiotic stewardshipinfectious diseases and/or antibiotic stewardship
CDC Core Elements of Hospital Antibiotic Stewardship Programs 2014. Available at h // d / /h l h /i l i / l h l
5
http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
Core element of ASPCore element of ASP
Leadership commitment – national, some h it lhospitals
Accountability and drug expertise Accountability and drug expertise Physician and pharmacist with formal training in
infectious diseases and/or antibiotic stewardshipinfectious diseases and/or antibiotic stewardship 200 full-trained infectious disease physicians
30 li i l h i t ith i f ti di t i i 30 clinical pharmacist with infectious disease training
CDC Core Elements of Hospital Antibiotic Stewardship Programs 2014. Available at h // d / /h l h /i l i / l h l
6
http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
Key supportKey support
Infection preventionists and hospital epidemiologists epidemiologists
Quality improvement staff ± Laboratory staff , ? Lab quality
Information technology staff competency? Information technology staff , competency? Nurses , unclear role
CDC Core Elements of Hospital Antibiotic Stewardship Programs 2014. Available at h // d / /h l h /i l i / l h l
7
http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
Key supportKey support
Infection preventionists and hospital epidemiologists epidemiologists
Quality improvement staff ± Laboratory staff , ? Lab quality
Information technology staff competency? Information technology staff , competency? Nurses , unclear role
CDC Core Elements of Hospital Antibiotic Stewardship Programs 2014. Available at h // d / /h l h /i l i / l h l
8
http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
Mind setMind set Just to be on the safe side, let’s put him on a (broad-spectrum) antibioticspectrum) antibiotic.
A i h i dAcute fever without localizing signs
Azithromycin and cefdinir were prescribed as home med
Suspected Dengue infection
as home med.
9
Mind setMind set Just to be on the safe side, let’s put him on a (broad-spectrum) antibioticspectrum) antibiotic.
10
Aim at minimizing the use of antibiotic inuse of antibiotic in common community-acquired infections not requiring such q gagents
11
ASU: Antibiotic Smart UseASU: Antibiotic Smart Use
WHO-supported Begun in 2007 in a central province with
600 k population, 14 community hospitals600 k population, 14 community hospitals Has now embed in the National Rational
Drug Use scheme, resulting in wider deployment of the activityp y y
1. J Med Assoc Thai 2014; 97 (Suppl. 3): S13-S19, Full text. e-Journal: http://www.jmatonline.com
12
2. J Med Assoc Thai 2015; 98 (10): 974-84 Full text. e-Journal: http://www.jmatonline.com
Clinical Infectious Diseases 2006; 42:768–75
13
TeamTeam
1 ID physician 1hospital id i l i t
1clinical microbiologist
epidemiologist 1 IC specialistmicrobiologist
4 pharmacists 1 IC specialist 1 computer system
2 internists analyst
14
Apisarnthanarak A., et al. CID 2006
ActivityActivity
Feedback Antibiotic order forms
Obligatory requirement for procuring the Obligatory requirement for procuring the drug from the pharmacy
Bedside discussion among the pharmacists clinical microbiologist andpharmacists, clinical microbiologist, and attending physicians
15
Apisarnthanarak A., et al. CID 2006
Outcomes: decreased resistanceOutcomes: decreased resistance
16
Apisarnthanarak A., et al. CID 2006
Example of computer-assisted p pantimicrobial prescription control
Derived from “Antibiotic Order Form” Allow initial empirical therapy
Aim at carbapenem Aim at carbapenem Very broad spectrum Increasing carbapenem-resistant Increasing use of carbapenem Increasing use of carbapenem Logistically feasible
17
Initial order will be process for 3 day supply then a renewal3-day supply, then a renewal is required
18
19
20
R i ti d 3• Renew prescription on day 3• Only “specific therapy” or ID staff prescribing are allowed• Specific therapy will be determined by the program which
links to Microbiology Report and look for “carbapenemlinks to Microbiology Report and look for carbapenem-susceptible only” pathogen
21
The use of carbapenem in hospitalThe use of carbapenem in hospital
100
120
Use rate (DDD/1000 Pt-day)
80
100
60
20
40
0
20
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 20162005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
22
23
Large scale implementation of ASPLarge scale implementation of ASP
24
Opportunity and ChallengesOpportunity and Challenges
Appropriate use of antimicrobial agent is a major component in the National AMR strategymajor component in the National AMR strategy
Physicians’ mind set “just to be on the safe side, let’s put them on antibiotics”
Laboratory support for physicians Laboratory support for physicians Lack of human resources in variety of
disciplinediscipline
25
Thank you for your attentionThank you for your attention
26