antimicrobial stewardship what’s in it for you!
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Antimicrobial Stewardship What’s In It For YOU!. Paul Pottinger, MD, DTM&H Director, UWMC Antimicrobial Stewardship Program February 11, 2014. Show of Hands…. Have you ever taken antibiotics? Whose life was saved by antibiotics?. Harsh Realities in USA. Abx for Humans: - PowerPoint PPT PresentationTRANSCRIPT
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ANTIMICROBIAL STEWARDSHIP
What’s In It For YOU!Paul Pottinger, MD, DTM&H
Director, UWMC Antimicrobial Stewardship Program
February 11, 2014
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Show of Hands…
1. Have you ever taken antibiotics?
2. Whose life was saved by antibiotics?
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• 20%• > 300 mil• 50%• 50%
Harsh Realities in USA
• Abx for Humans:• Abx Courses / yr: • Abx for Outpatients:• Abx Appropriate:
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An InconvenientTruth?
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• Abx Resistance is on the rise (and it’s our fault).
• Abx discovery pipeline is all but dry.
• We must control our destiny.
Brutal Truths
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Physicians are not happy about any of this.
“How should medical science respond?”
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• Public Policy MakersKey Players Must Respond!
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• Public Policy Makers
GAIN act now law!
Key Players Must Respond!
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• Public Policy MakersKey Players Must Respond!
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• Public Policy Makers• Researchers
Key Players Must Respond!
New Medications… and Beyond!
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• Lactobacillus crispatus is normal vaginal flora, drives down pH, keeps E.coli at bay.
• Phase 2 trial of Lactin-V (Ocel) Suppositories (daily x 5, then weekly x 10)
Outcome L.crispatus (n=48)
Placebo (n=48)
Analysis
UTI Recurrence
7/48 (15%) 13/48 (27%) RR 0.5
CI 0.2-2.1High Level Vaginal E.coli colonization
RR 0.07 RR 1.1 P<0.01
Stap
leto
n C
ID 2
011
The Future: Pro-Biotics?
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Immunizations for Bad Bugs?• Limitation: Normal Flora Pathogen.• May still be feasible versus high-profile non-
symbionts.
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Study Limitations Animal model. Limited repertoire of Staph isolates. PNA examined, not SSTI or BSI.
Potential of MRSA Vaccine Extraordinary potential benefits…
Unanticipated consequences?
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• Public Policy Makers• Researchers• Clinicians
Key Players Must Respond!
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Clinical Infectious Diseases 2013;57(5):631–8
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Abx Training at UW, JHU, Miami4th - Year MD students surveyed several weeks before graduation…Education Good / Very Good: 30-60%• Basic ID case scenarios: 51% correct• Information sources: Huge diversity
(textbooks, manuals, peers, attendings, UTD, Wikipedia…)
• Heard of Abx Stewardship: 40%WE CAN DO BETTER!
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“Antimicrobial Control”
What’s in a Name?
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“Antimicrobial Control”“Antimicrobial Management”
What’s in a Name?
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“Antimicrobial Control”“Antimicrobial Management”“Antimicrobial Stewardship”
What’s in a Name?
Stew·ard (noun): A person whose responsibility it is to take care of something.
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“Spiraling Empiricism”Broad-Spectru
m Coverag
eMDRO Selectio
n
Diagnostic
Uncertainty
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12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults
12 Break the chain11 Isolate the pathogen
10 Stop treatment when cured 9 Know how to say no to vanco 8 Treat infection, not colonization 7 Treat infection, not contamination
6 Use local data 5 Practice antimicrobial control 4 Access the experts 3 Target the pathogen
2 Get the catheters out 1 Vaccinate
Prevent Xmission
Use Abx Wisely
Dx & Rx EffectivelyPrevent Infections
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
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Newer, Fancier, Pricier ≠ Better!
Linezolid TMP/SMX
For MRSA SSTI….
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VAP
CABSI
CAUTI
Pottinger’s Axiom: Time + Tube = Trouble
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Ignac Semmelweis(1818-65)
“Clean Your *&^%@! Hands”• Hand Hygiene Remains Cornerstone of IC• Biggest Cost:Benefit Ratio Around• Patients Will Thank (or Chastise) You!• Obey Precaution Placards
Prevent Infection
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• Public Policy Makers• Researchers• Clinicians• Patients
Key Players Must Respond!
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If you’re not angry—or alarmed—you have not been paying attention.
“What can I DO?”
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P2I WANT YOU…
To help bring antibiotic useunder control!
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P2
Become an antibiotic steward!
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Take Care of Each Other!
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Abx Stewardship: Conclusions
“Our vs. Their Genes” • Few new abx coming…• Abx resistance is our fault… • Fixing this is our responsibility…• Respect needs & patterns globally• Together, we can do it!
Brains
THANK YOU