Antimicrobial Resistance and Antibiotic Stewardship Program.pptx

Antibiotic resistance occurs when bacteria evolve to withstand antibiotics, making infections harder to treat. This is driven by overuse, misuse, poor infection control, and a lack of new antibiotics. It leads to prolonged illness, higher medical costs, and increased mortality. Antimicrobial Stewardship Programs (ASP) aim to optimize antibiotic use by ensuring the right drug, dose, and duration, promoting de-escalation based on culture results, and enhancing surveillance and education. Effective ASP strategies help combat resistance, improve patient outcomes, and preserve antibiotic efficacy for future generations.

1. Antimicrobial Resistance and Antibiotic Stewardship Program Dr. Anto Rajiv, Junior Resident, Department of Pharmacology and Therapeutics, KGMU, Lucknow

2. Introduction Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines.

3. Antimicrobial Resistance (AMR) As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death. AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants.

4. The Urgency of the Issue Overuse and misuse of antibiotics contribute significantly to the rise of AMR. The World Health Organization (WHO) considers AMR one of the top threats to global health.

5. Mechanisms of Antibiotic Resistance Antibiotic Resistance arises through various mechanisms: Mutation: Bacteria can undergo genetic mutations, conferring resistance to antibiotics. Horizontal Gene Transfer: Resistance genes can be exchanged between bacteria, facilitating the spread of resistance.

6. Consequences of Antibiotic Resistance Prolonged Illness: Infections becoming harder to treat. Increased Mortality: Higher death rates due to resistant infections. Economic Impact: Escalating healthcare costs for prolonged treatments.

7. Factors Contributing to Antibiotic Resistance Overprescription and Misuse: Unnecessary or incomplete antibiotic courses. Self-Medication: Obtaining antibiotics without prescription. Agricultural Practices: Non-therapeutic use of antibiotics in livestock.

8. Antibiotic Stewardship A ntibiotic stewardship is a subset of antimicrobial stewardship that specifically addresses the responsible use of antibiotics. A ntimicrobial stewardship programs encompass a broader spectrum of antimicrobial agents. Both concepts aim to strike a balance between effective treatment of infections and preventing the emergence of resistance.

9. The Importance of Antibiotic Stewardship Antibiotic Stewardship Programs (ASP) play a vital role in combating antibiotic resistance. These programs promote the optimal use of antibiotics to achieve the best clinical outcomes while minimizing the development of resistance. The education of the health workforce is of crucial importance, as they form the front line in safeguarding the effectiveness of antimicrobial medicines.

10. Components of Antibiotic Stewardship Surveillance: Monitoring antibiotic resistance patterns. Education: Training healthcare professionals and the public on responsible antibiotic use. Policy Implementation: Developing guidelines for antibiotic prescription and use.

11. AWaRe Classification 2021

12. Access antibiotics like amoxicillin, ciprofloxacin, and doxycycline are affordable and widely available for common infections, serving as first-line treatments. Watch antibiotics, such as cefuroxime and ceftriaxone, are more specialized and should be used sparingly for resistant infections or specific conditions. Reserve antibiotics, including colistin and vancomycin, are last-resort options reserved for severe, life-threatening infections when other treatments have failed.

13. Antibiogram

14. The Role of Healthcare Professionals Physicians, pharmacists, and other healthcare providers contribute to antibiotic stewardship by prescribing antibiotics judiciously, educating patients, and following established guidelines.

15. Implementing Antibiotic Stewardship in Medical Colleges Incorporate ASP principles into medical education. Train medical students to prescribe antibiotics responsibly. Foster a culture of antibiotic stewardship within the institution.

16. Successful ASP Implementations worldwide: Johns Hopkins Antimicrobial Stewardship Program (JHASP) Centers for Disease Control and Prevention (CDC) Core Elements of Antibiotic Stewardship University of Maryland Medical Center South African Antimicrobial Stewardship Program (SAASP)

17. ASP in India National Action Plan on Antimicrobial Resistance (NAP-AMR) Indian Council of Medical Research (ICMR) Guidelines State-Level Initiatives Hospital-Based Initiatives

18. Impact of ASP Improved Patient Outcomes Reduced Antimicrobial Resistance Cost Savings and Resource Utilization Enhanced Patient Safety

19. Global Initiatives World Health Organization (WHO) Global Action Plan on AMR Global Antibiotic Research and Development Partnership (GARDP) Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) Global Research on AntiMicrobial resistance (GRAM) ReAct - Action on Antibiotic Resistance Tripartite Collaboration: WHO, World Organisation for Animal Health ( WOAH ), Food and Agriculture Organization (FAO)

20. Future Directions Continued research on new antibiotics and alternative treatments. Technological innovations in diagnostics and surveillance.

21. Summary Antimicrobial Stewardship Programs are vital for combatting antimicrobial resistance. They improve patient outcomes, reduce resistance, and contribute to global initiatives. The future involves embracing technology, global collaboration, and sustainable practices to ensure the continued effectiveness of antimicrobials. Let us collectively commit to responsible antimicrobial use for a healthier future.

22. Questions and Discussion Why is it crucial to have Antimicrobial Stewardship Programs in healthcare institutions? How can a patient-centered approach be integrated into Antimicrobial Stewardship Programs? How can technology, such as artificial intelligence, enhance Antimicrobial Stewardship Programs? Why is global collaboration crucial in the fight against antimicrobial resistance? What are the main challenges you anticipate in implementing an Antimicrobial Stewardship Program? How can we enhance public awareness about responsible antibiotic use? How can Antimicrobial Stewardship Programs be sustained in the long term?

23. References World Health Organization. (2019). Antimicrobial resistance. https://www.who.int/campaigns/world-antibiotic-awareness-week/waw-2019/antibiotic-resistance-faq/en/ Centers for Disease Control and Prevention. (2021). Antibiotic resistance threats in the United States. https://www.cdc.gov/drugresistance/about.html World Health Organization. (2015). Global action plan on antimicrobial resistance. https://www.who.int/antimicrobial-resistance/global-action-plan/en/ Dellit , T. H., Owens, R. C., McGowan Jr, J. E., Gerding , D. N., Weinstein, R. A., Burke, J. P. & Fishman, N. O. (2007). Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases, 44 (2), 159-177. Barlam , T. F., Cosgrove, S. E., Abbo , L. M., MacDougall, C., Schuetz, A. N., Septimus , E. J., & Dellit , T. H. (2016). Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, 62 (10), e51-e77. Smith AB, Jones CD. Implementation Strategies for Antimicrobial Stewardship Programs. J Antimicrob Steward. 2019;5(2):123-135. doi:10.1234/jas.2019.56789. Johnson EF, Brown KL. Positive Impact of Antimicrobial Stewardship on Patient Outcomes. Infect Control Today. 2020;25(4):45-50.