Antimicrobial Stewardship Program: Local Experience
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1 Antimicrobial Stewardship Program: Local Experience Dr. WU Tak Chiu Associate Consultant Division of Infectious Diseases Department of Medicine Queen Elizabeth Hospital 18th January 2011
2 QUEEN ELIZABETH HOSPITAL SINCE 1963 Is the largest hospital in Hong Kong Operates a 24-hour Accident and Emergency service and a full spectrum of specialist services. Provides medical care in both inpatient and specialist outpatient services. Is a referral centre of the major specialities
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4 Multiple resistant organisms VISA / VRSA VRE Multiple drug resistant Pseudomonas aeruginosa Multiple drug resistant Acinetobacter Baumannii
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6 MDROs
7 ñ Hospital stay MDROs ñ Morbidity ñ Mortality ñ Cost
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9 Tigecycline Moxifloxacin Doripenem Cefepime Azithromycin Tazocin
10 Development of new antibiotics lagging behind of MDROs development
11 Antibiotic History Drugs Year Sulphonamides 1932 Penicillin 1940 Streptomycin 1944 Chloramphenicol 1947 Cephalosporin 1948 Erythromycin 1952 Vancomycin 1956 Nalidixic acid (1st FQs) 1962 (1970s) Oxazolidinone (Linezolid) 1978 (2002) Lipopetide (Daptomycin) 1980 (2003)
12 Antibiotic Pressure Antimicrobial Agent Resistance Gene
13 Appropriate Antibiotic Use Not only to the total amount, but how it is being used. Inappropriate use of antibiotics will select for bacterial resistance. Excessive duration may exacerbate disruption of the normal flora
14 In
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17 Antimicrobial Stewardship Program in
18 Membership of ASP Members Dr. Wu Tak Chiu Dr. Dominic Tsang Dr. Patrick Li Dr. C S Li Dr. Wilson Leung Division of Infectious Diseases Clinical Microbiology Consultant Medicine (Chief of Service) Drug and Therapeutic Committee (Chairman) Clinical Pharmacist
19 Objectives 1. Optimizing choice and dosing of both empirical and definitive antimicrobial therapy 2. Improving hospital antibiotic resistance profile 3. Improving clinical outcomes of patients who require antimicrobial therapy
20 Strategies 1. Written Guidelines IMPACT and Hospital guidelines 2. Educational Efforts Teaching sessions 3. Providing ID consultations on the use of antibiotics 24hrs ID consultation service 4. Antibiotic susceptibility report 5. Restriction and audit of selected antimicrobial agents prescriptions 6. Hospital Antibiotic usage and resistance monitoring Restricted antibiotic susceptibility report Restricted use of selected antibiotics Antibiotic Order Form Immediate concurrent feedback Monthly and annual antimicrobial usage report Hospital Antibiogram
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22 19 Targeted Antimicrobial Drugs Anti-MRSA Vancomycin Linezolid Carbapenems Imipenem Ertapenem Meropenem Antipseudomonal Cefoperazpone/Sulbactam (Sulperazon) Cefepime Ceftazidime (Fortum) Piperacillin-Tazobactam (Tazocin) IV Fluoroquinolones Levofloxacin Moxifloxacin Ciprofloxacin IV Macrolides Azithromycin Clarithromycn Antifungal Drugs IV Fluconazole Caspofungin Voriconazole Others Tigecycline Colistin
23 Outcomes Patient Quality of Care: Mortality rates & ALOS of QEH medical patients with primary diagnosis of pneumonia Antibiotic Resistance Trend: Microbiology susceptibility report on PA Incidence of MRPA (multiply-resistant P. aerugoinosa) Antibiotic Consumption: Cost (HK$) DDD(Defined daily dose)/1000 patient-bed days
24 WHO DDD Definition Is assumed average maintenance dose per day for a drug used for its main indication in adults Not necessarily reflect the recommended or prescribed daily dose Give a rough estimation of consumption Fixed unit of a measurement independent of price or formulation Able to assess the trend in drug consumption and To perform comparison between the population groups
25 Departments Medicine O&T Surgery
26 Daily ASP Work-Flow Prescriptions of antibiotics by in-charge doctors
27 Daily ASP Work-Flow Prescriptions of antibiotics by in-charge doctors Antibiotic Order Form Pharmacy collects the AOFs Infection Control Nurse collects clinical information Case review by ID/Microbiologist Immediate Concurrent Feedback given if inappropriate
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32 Summary ASP: Reduction of targeted antibiotic consumption Control of MDRPA outbreak Improvement of PA ST profile Improvement of clinical outcomes and shortened ALOS of patients with pneumonia
33 Keys to success Blessing from top hospital management Multidisciplinary team Strategic approach Immediate Concurrent Feedback Manpower Continuous monitoring
34 Acknowledgement ASP Team Dr. Dominic Tsang Dr. Wilson Lam Dr. Stephenie Wong Dr. Chu Man Yee Dr. Naomi Cheng Dr. Wilson Leung Dr. Christopher Lai Ms. Kitty Ng Ms. Doris Poon and ICNs
35 Thank You.
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