antimicrobial stewardship: a competency based approach
TRANSCRIPT
" Antimicrobial resistance is a crisis that
must be managed with the utmost
urgency. …We cannot allow hard-won
gains for health to be eroded by the
failure of our mainstay medicines.”
Dr. Margaret Chan
2015 WHO Global
Action Plan on
Antimicrobial
Resistance
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1) Improve awareness and understanding of AMR through effective
communication, education and training
2) Strengthen knowledge through surveillance and research
3) Reduce the incidence of infection
4) Optimize the use of antimicrobial medicines in human and animal
health
5) Develop the economic case for sustainable investment (in AMR)
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1) Improve awareness and understanding of AMR through
effective communication, education and training
2) Strengthen knowledge through surveillance and research
3) Reduce the incidence of infection
4) Optimize the use of antimicrobial medicines in human and animal
health
5) Develop the economic case for sustainable investment (in AMR)
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1) Improve awareness and understanding of AMR through
effective communication, education and training
2) Strengthen knowledge through surveillance and research
3) Reduce the incidence of infection
4) Optimize the use of antimicrobial medicines in human and
animal health
5) Develop the economic case for sustainable investment (in AMR)
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Antimicrobials are societal drugs
Antimicrobial resistance
An
tim
icro
bia
l
use
Using antimicrobials wisely
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We must all be antimicrobial stewards
Stewardship:
the careful and responsible
management of natural
resources
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We must all be antimicrobial stewards
Drug
Dose
Duration
Routeprescription
.............
.............
.............
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Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of infection
Minimise duration of therapy
Ensure monotherapy in most cases
We must all be antimicrobial stewards
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Course framework:
the clinician-patient encounter
Subsequent evaluationInitial evaluation
Clinical
assessment
Diagnostic
work-up
Patient
education
Therapeutic
decisions
Modify
antimicrobialsData
review
Clinical
re-assessment
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Initial evaluation
Clinical
assessment
Diagnostic work-up
Patient education
Therapeutic decisions
Course framework:
Initial evaluation
15
Initial evaluation
Clinical
assessment
Diagnostic work-up
Patient education
Therapeutic decisions
Course framework:
Initial evaluation
16
Initial evaluation
Clinical
assessment
Diagnostic work-up
Patient education
Therapeutic decisions
Course framework:
Initial evaluation
17
Initial evaluation
Clinical
assessment
Diagnostic work-up
Patient education
Therapeutic decisions
Course framework:
Initial evaluation
18
Initial evaluation
Clinical
assessment
Diagnostic work-up
Patient education
Therapeutic decisions
Course framework:
Initial evaluation
19
Subsequent evaluation
Modify
antimicrobials
Data review
Course framework:
Subsequent evaluation
Clinical re-
assessment
20
Subsequent evaluation
Modify
antimicrobials
Data review
Course framework:
Subsequent evaluation
Clinical re-
assessment
21
Subsequent evaluation
Modify
antimicrobials
Data review
Course framework:
Subsequent evaluation
Clinical re-
assessment
22
Subsequent evaluation
Modify
antimicrobials
Data review
Course framework:
Subsequent evaluation
Clinical re-
assessment
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Principles of optimal antimicrobial use
Initial evaluation
Subsequent evaluationInitial evaluation
Clinical
assessment
Diagnostic
work-up
Patient
education
Therapeutic
decisions
Modify
antimicrobialsData
review
Clinical
re-assessment
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Core competencies for antimicrobial
prescribing
C1: Understands the patients and their clinical needs
C2: Understands treatment options and how they support the
patient’s clinical needs
C3: Works in partnership with the patient and other healthcare
professionals to develop and implement a treatment plan
C4: Communicates the treatment plan and its rationale clearly to
the patient and other health professionals
C5: Monitors and reviews the patient’s response to treatment
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Core competencies C1, C2, C3, C4, C5
Subsequent evaluationInitial evaluationSubsequent evaluationInitial evaluation
Clinical
assessment
Diagnostic
work-up
Patient
education
Therapeutic
decisions
Modify
antimicrobialsData
review
Clinical
re-assessment
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Questions for front-line clinician
If yes, what drug is the best choice?
Are antimicrobials indicated?
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Questions for front-line clinician
How can I limit the societal impact of this antimicrobial use?
If yes, what drug is the best choice?
Are antimicrobials indicated?
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Marisa Holubar, MD MS Elizabeth Robilotti, MD MPHClinical Assistant Professor, Infectious Diseases Assistant Attending, Infectious DiseasesAssociate Director, Stanford Antimicrobial Safety Associate Director, Infection Control
& Sustainability Program Memorial Sloan Kettering Cancer CenterStanford University School of Medicine
Stan Deresinski, MDClinical Professor, Infectious DiseasesDirector, Stanford Antimicrobial Safety
& Sustainability ProgramStanford University School of Medicine
Course content developed by:
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Tjalling Leenstra, MD PhD Head, WHO Collaborating Centre for Antimicrobial Resistance Epidemiology and Surveillance Centre for Infectious Disease Control National Institute fro Public Health and the EnvironmentThe Netherlands
Muna ABU SIN, MD, MScRobert Koch-InstituteDepartment for Infectious Disease Epidemiology Healthcare-associated Infections, Surveillance of Antibiotic Resistance and ConsumptionGermany
Hrachuhi Ghazaryan, MDGeneral PaediatricianHead of General Paediatric departmentArabkir Joint Medical centreAssistant Professor in Yerevan State Medical University after M. Heratsi, chair of Paediatrics N2Yerevan, Armenia
Course content reviewed by:
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Saskia Nahrgang, MD MPH
Technical Officer Programme Control of Antimicrobial Resistance
WHO Regional Office for Europe
Danilo Lo Fo Wong, PhD
Programme Manager, Programme Control of Antimicrobial Resistance
WHO Regional Office for Europe
WHO advisors:
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References: General
• World Health Organization. Global Action Plan on Antimicrobial Resistance. Sixty-
eighth World Health Assembly (document WHA68/2015/REC/1, Annex 3.
http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf
• Fleming-Dutra KE, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among
US Ambulatory Care Visits, 2010 – 2011. JAMA 2016 May 3; 315(17):1864-73. doi:
10.1001/jama.2016.4151.
• The Review on Antimicrobial Resistance Chaired by Jim O’Neill. Tackling drug-
resistant infections globally: Final report and recommendations. May 2016.
http://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
• Centers for Disease Control and Prevention. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013. http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-
508.pdf
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References: Core Competencies
https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20sta
ndards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf
https://www.nps.org.au/__data/assets/pdf_file/0004/149719/Prescribing_Competencies_Framework.pdf
https://www.gov.uk/government/publications/antimicrobial-prescribing-and-stewardship-competencies
http://apps.who.int/medicinedocs/pdf/whozip23e/whozip23e.pdf
http://www.gmc-uk.org/Prescribing_guidance.pdf_59055247.pdf
http://www.euro.who.int/__data/assets/pdf_file/0010/288253/HWF-Competencies-Paper-160915-final.pdf?ua=1
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