Bug Squad 101 and Other Antibiotic Pearls

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Bug Squad 101 and Other Antibiotic Pearls

• Chelsea Mannebach
• September 21st, 2011

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Objectives

• Explain the purpose and goals of Bug Squad
• Discuss the importance of appropriate
  antimicrobial utilization
• Describe clinical pearls relating to antibiotic
  administration

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Audience Poll

• What do you know about Bug Squad?
• (Have you ever heard about Bug Squad?)

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Bug Squad

• Multidisciplinary team
• Microbiology
• Infection prevention
• Medicine
• Pharmacy
• Twice weekly meetings
• Goal
• Antimicrobial stewardship/appropriate
  antimicrobial utilization

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Audience Poll

• Why target antimicrobials?

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Issues

• 10-30 of the average hospital pharmacy budget is
  spent on antimicrobials
• Up to 50 of antibiotic use in hospitals is
  estimated to be inappropriate
• Increasing rate of bacterial resistance thought
  to be in part due to antibiotic use
• Improvements in antimicrobial use has been shown
  to improve patient outcomes and reduce resistance
  rates
• Decreased number of antimicrobial drugs in
  pipeline

From Antimicrobial Stewardship, Jamie Winner.
Management of Infectious Diseases 32nd Annual
Madison Clinical Conference. March 30, 2011.
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Audience Poll

• What is antimicrobial stewardship?

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Antimicrobial Stewardship Goals

• Optimize patient outcomes through improved
  antimicrobial utilization
• Efficacy
• Toxicity
• Resistance
• Reduce health care costs without adversely
  impacting quality of care
• Length of stay
• Drug cost

From Antimicrobial Stewardship, Jamie Winner.
Management of Infectious Diseases 32nd Annual
Madison Clinical Conference. March 30, 2011.
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Microbiology

• Culture information
• Latest reports help guide de-escalation and
  appropriate antibiotic selection
• Insight
• Resistance Data
• Antibiogram
• Problem Bugs
• MRSA (Methicillin Resistant Staphylococcus
  Aureus)
• ESBLs (Extended Spectrum Beta Lactamases)
• VRE (Vancomycin Resistant Enterococci)
• KPCs (Klebsiella Pneumoniae Carbapenemases)
• C. difficile

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Audience Poll

• Why de-escalate?

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De-escalation

• Reduces selection pressure responsible for
  antimicrobial resistance by decreasing
  antimicrobial exposure
• Contains costs
• Reduces the risk of adverse events

From Antimicrobial Stewardship, Jamie Winner.
Management of Infectious Diseases 32nd Annual
Madison Clinical Conference. March 30, 2011.
12
Antibiogram

• Susceptibility rates
• Minimum Inhibitory Concentration (MIC)
  breakpoints
• Dosing information
• Cost data

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Infection Prevention

• VAP
• Ventilator-associated pneumonia
• CAUTI
• Catheter-associated UTI
• CLABSI
• Central line-associated blood stream infection

• Isolation requirements
• MRSA
• c. difficile
• ESBLs
• Viruses (roto, RSV, influenza)
• Meningitis (neisseria)
• Sepsis Campaign
• Protocols
• Criteria
• Mortality rate
• Public Health

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Medicine

• Dr. Gray
• pathology
• Dr. Skeem
• internists
• Dr. Workman
• surgery

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Pharmacy

• Selection and streamlining
• Dose optimization
• Patient characteristics
• renal function, age, weight
• Site of infection
• meningitis, neutropenic fever, pneumonia
• Pharmacokinetics
• monitoring levels
• IV to PO Conversion

From Antimicrobial Stewardship, Jamie Winner.
Management of Infectious Diseases 32nd Annual
Madison Clinical Conference. March 30, 2011.
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Outcome Measurements

• Microbiologic
• Susceptibilities and resistance
• Number of infections due to specific organisms
• Clinical
• Adverse drug events
• Mortality
• Clinical cure
• Length of stay
• Readmission rates
• Financial
• Cost savings

From Antimicrobial Stewardship, Jamie Winner.
Management of Infectious Diseases 32nd Annual
Madison Clinical Conference. March 30, 2011.
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Antibiotic Clinical Pearls

• Sepsis
• Source control
• Timeliness
• Pharmacokinetics
• Therapeutic window
• Monitoring levels
• Time dependent vs. concentration dependent

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Sepsis

• 50-70 mortality
• Mortality increases 7-10 every hour if not
  treated with goal-directed care
• Sepsis Campaign (started 2002)
• Reduce mortality to 25
• Goal-directed therapy
• Reperfusion
• Labs and cultures
• Source control
• Antibiotics

Surviving sepsis campaign international
guidelines for management of severe sepsis and
septic shock 2008. 2004 (revised 2008 Jan).
NGC006316. Society of Critical Care Medicine
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Pharmacokinetics

• Concentration-dependent Antibiotics
• Fluoroquinolones
• Aminoglycosides

• Time-dependent Antibiotics
• Vancomycin
• B-lactams

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Summary

• Dry pipeline, we are stuck with what we have
• Bugs are smart
• Essential that we protect our patients and our
  antimicrobials
• Nursing plays an important role in ensuring
  appropriate and timely antimicrobial
  administration

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Questions?