A NTIMICROBIAL S TEWARDSHIP What’s In It For YOU! Paul Pottinger, MD, DTM&H Director, UWMC...
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Transcript of A NTIMICROBIAL S TEWARDSHIP What’s In It For YOU! Paul Pottinger, MD, DTM&H Director, UWMC...
ANTIMICROBIAL STEWARDSHIP
What’s In It For YOU!Paul Pottinger, MD, DTM&H
Director, UWMC Antimicrobial Stewardship Program
February 11, 2014
• 20%
• > 300 mil
• 50%
• 50%
Harsh Realities in USA
• Abx for Humans:
• Abx Courses / yr:
• Abx for Outpatients:
• Abx Appropriate:
• 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
• 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 0.2-2.1
High Level Vaginal E.coli colonization
RR 0.07 RR 1.1 P<0.01
Sta
ple
ton
CID
201
1
The Future: Pro-Biotics?
Immunizations for Bad Bugs?
• Limitation: Normal Flora Pathogen.• May still be feasible versus high-profile non-
symbionts.
Study Limitations Animal model. Limited repertoire of Staph isolates. PNA examined, not SSTI or BSI.
Potential of MRSA Vaccine Extraordinary potential benefits…
Unanticipated consequences?
Abx Training at UW, JHU, Miami
4th - 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!
“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.
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
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