Antimicrobial stewardshipPHARMD CONSULTS
Antimicrobial stewardship
is a set of coordinated strategies to improve the appropriate use of antimicrobial agents (such as antibiotics, antivirals, antifungals, and antiparasitic drugs). The goal is to optimize clinical outcomes while minimizing the unintended consequences of antimicrobial use, such as antimicrobial resistance, toxicity, and the spread of healthcare-associated infections.
Key components of antimicrobial stewardship programs typically include:
- Guidelines and Policies: Establishing evidence-based guidelines and protocols for the appropriate use of antimicrobial agents across healthcare settings.
- Education and Training: Providing education and training to healthcare professionals, including physicians, pharmacists, and nurses, on antimicrobial resistance, appropriate antimicrobial prescribing practices, and the importance of stewardship.
- Antimicrobial Review: Implementing systems for regular review of antimicrobial prescribing practices, including prospective audit and feedback, to ensure that antimicrobials are prescribed only when necessary and appropriate.
- Antimicrobial Formulary Management: Developing and maintaining a hospital formulary that promotes the optimal use of antimicrobial agents, including restrictions on certain high-risk antibiotics and promotion of narrower spectrum agents when appropriate.
- Surveillance and Monitoring: Monitoring antimicrobial use and resistance patterns within healthcare facilities to identify trends, outbreaks, and opportunities for improvement.
- Multidisciplinary Collaboration: Engaging a multidisciplinary team, including infectious disease specialists, pharmacists, microbiologists, infection preventionists, and hospital administrators, to implement and oversee antimicrobial stewardship activities.
- Patient and Public Education: Educating patients and the public about the appropriate use of antimicrobial agents, including the importance of completing prescribed courses of antibiotics and avoiding unnecessary antibiotic use for viral infections.
By implementing antimicrobial stewardship programs, healthcare facilities can improve patient outcomes, reduce healthcare costs, and mitigate the growing threat of antimicrobial resistance.
Antibiotic resistance genes (ABR genes) are genetic elements that encode proteins or enzymes that confer resistance to antibiotics in bacteria. These genes can be naturally occurring in bacterial populations or acquired through mutation or horizontal gene transfer, where bacteria exchange genetic material with each other.
ABR RESISTANCE GENES
Some common types of antibiotic resistance genes include:
- Beta-lactamase genes: These genes encode enzymes called beta-lactamases that can hydrolyze beta-lactam antibiotics, rendering them ineffective. Examples include the blaTEM, blaCTX-M, and blaSHV genes.
- Aminoglycoside resistance genes: These genes encode enzymes that modify or inactivate aminoglycoside antibiotics, such as gentamicin and kanamycin. Examples include the aac(6′)-Ib and aph(3′)-Ia genes.
- Tetracycline resistance genes: These genes encode efflux pumps or ribosomal protection proteins that prevent tetracycline antibiotics from binding to bacterial ribosomes or facilitate their removal from the bacterial cell. Examples include the tet(A), tet(B), and tet(M) genes.
- Macrolide resistance genes: These genes encode enzymes that modify or methylate bacterial ribosomes, preventing macrolide antibiotics from binding and inhibiting protein synthesis. Examples include the erm(B) and erm(A) genes.
- Quinolone resistance genes: These genes encode proteins that modify bacterial DNA gyrase or topoisomerase IV, the targets of quinolone antibiotics, reducing their ability to bind and inhibit bacterial DNA replication. Examples include the qnr and aac(6′)-Ib-cr genes.
- Glycopeptide resistance genes: These genes encode enzymes that modify bacterial cell wall precursors, preventing glycopeptide antibiotics such as vancomycin from binding and inhibiting cell wall synthesis. Examples include the vanA, vanB, and vanC genes.
The presence and dissemination of antibiotic resistance genes pose a significant public health challenge, as they can lead to treatment failures and the spread of multidrug-resistant bacteria. Strategies to combat antibiotic resistance include antimicrobial stewardship, infection control measures, development of new antibiotics, and alternative therapies.
ANTIMICROBIAL STEWARDSHIP
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