ruola della antimicrobial stewardship cdi.ppt [modalità ... · strategies for controlling...
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Nicola Petrosillo
Dipartimento Clinico e di Ricerca in Malattie InfettiveIstituto Nazionale per le Malattie Infettive «Lazzaro
Spallanzani”, IRCCS, Roma
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Competing interests disclosure
• Honorary as speaker for Astellas, MSD, Pfizer, Novartis, B&D, Gilead, GSK, Johnson & Johnson, Angelini, Zambon
• Honorary as member of scientific board for Pfizer, MSD, Astellas, Novartis, B&D.
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Cassini A et al.
Estimate of 2,609,911 new cases of HAI occurring every year in EU/EEA
91,130 deathsfor the sixHAIs
5 Boeing 787s crashing per weekat least 1/2 of the deaths attributable to HAI due to the 7 most common MDRB
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Background
� Threats of MDR organisms and public health emergencies have exposed the need for more robust antimicrobial stewardship and for collaboration in the emergency preparedness.
� There is a need for coordinated efforts to effectively manage this «new deal».
� However, financial pressures are likely to compete with the expanding roles and expectations of physician-epidemiologists in IPC.
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What is antimicrobial stewardship?
• A strategy, a coherent set of actions designed to use antimicrobial responsibly.
• Responsible use: it should be defined and translated into context- and time-specific actions
Dyar OJ et al. Clin Microb Infection 2017 on press
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Dyar OJ et al. Clin Microb Infection 2017 on press
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Dyar OJ et al. Clin Microb
Infection 2017 on press
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Dyar OJ et al. Clin Microb Infection 2017 on press
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Antibiotic stewardship: does it work in hospital practice?
Marlies EJL et al. Clin Microb Infection 2017
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Antibiotic stewardship: does it work in hospital practice?
Marlies EJL et al. Clin Microb Infection 2017
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Davey P et al.
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Davey P et al.
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Outcomes and Metrics for Antimicrobial Stewardship: Survey of Physicians and Pharmacists.
Bumpass JB et al, Clin Infect Dis 2014;59:S108–11
Respondents’ Opinion
In March 2012, a 55-question online survey was e-mailed to 94 physicians or pharmacists in acute care hospitals in the United States. Response rate was around 52%.
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Beardsley JR et al. Infect Control Hosp Epidemiol 2012;33:398-400
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Strategies for controlling transmission of multidrug-resistant (MDR) pathogens in the intensive
care unit (ICU)
• Reduce selection pressures
– Improved antimicrobial (including disinfectants?) stewardship
– Ensure balancing measures are also considered
• Prevent spread (targeted or vertical strategies)
– Screening strategies
– Improve infection control e.g. hand hygiene, isolation measures
• Consider decolonisation (Horizontal strategies)
Reducing the reservoir and perhaps increasing colonisation resistance?
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The marriage between ASP and IPC
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Kawamura H et al. Am J Infect Control 2016; 44: 210-4
•Contact precautions and antimicrobial stewardship are effective in preventing nosocomial MRSA infections.
•Before-after study� implementation of a bundle approach consisting of MRSA active surveillance, contact precautions for MRSA positive patients, and CFZ based AMP stewardship
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Kawamura H et al. Am J Infect Control 2016; 44: 210-4
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Kawamura H et al. Am J Infect Control 2016; 44: 210-4
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Frenette C et al. Am J Infect Control 2016; 44: 977-82
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The intervention consisted of
•Antimicrobial stewardship•Hospital staff education•Active surveillance cultures•Contact precautions•Environmental cleaning•Disinfection enforcement•Hand hygiene promotion
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Viale P et al. Clin Microbiol Infect 2014
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Pulcini C et al. Clin Microbiol Infect 2014; 20: 963-72
• Review of 31 studies� 7 RCTs, before/after
controlled studies or before/after uncontrolled styudies with interrupted-time-series analysis.
• IDS intervention was associated with a significant improvemente on the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input.
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Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at
Veterans Health Administration Hospitals, 2003-2014
Goto M et al. JAMA Intern Med 2017; 177(10): 1489-1497
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Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at
Veterans Health Administration Hospitals, 2003-2014
Goto M et al. JAMA Intern Med 2017; 177(10): 1489-1497
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Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at
Veterans Health Administration Hospitals, 2003-2014
Goto M et al. JAMA Intern Med 2017; 177(10): 1489-1497
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Tagashira Y et al. Am J Infect Control 2016;44(6):708-10
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McQuillen DP et al. J Infect Dis 2017;216(suppl_5):S588-S593
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McQuillen DP et al. J Infect Dis 2017;216(suppl_5):S588-S593
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McQuillen DP et al. J Infect Dis 2017;216(suppl_5):S588-S593
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Tedeschi S et al. Infect Control Hosp Epidemiol 2017;38(1):76-82.
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Tedeschi S et al. Infect Control Hosp Epidemiol 2017;38(1):76-82.
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Cataldo AM et al. Expert Rev Antiinfect Ther 2017
Effect of FQ ASP on CDI incidence
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Dia-gnosticStewardship
Infection PreventionStewardship
Thera-pyAntimicrobial Stewardship (A-Teams)
From competence to meta-competence
ID-doctor
Clin. Microbiol.ABS
Moleculair Medisch Microbioloog
Infection ControlPractitioner
Clin. Microbiol- infection prevention
Pharmacist
PHS
Intensivist
Dik et al. 2015 Future MicrobiologyCourtesy Prof. A
Friedrich
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