Antibiotic Policies: Fighting Resistance (eBook)

Contents 5
Contributors 7
Foreword 10
Preface 12
Consequences of Antimicrobial Chemotherapy: Overgrowth, Resistance, and Virulence 13
Summary 13
Introduction 13
Aspects of Virulence: Quorum Sensing 15
Aspects of Virulence: Toxin Production 16
Aspects of Virulence: Horizontal Transfer of Virulence and Resistance Genes 18
Aspects of Virulence: Bacterial Adhesion 18
Aspects of Virulence: Pathogen Persistence 19
Pathogen Persistence: Small-Colony Variants 20
Pathogen Persistence: Biofilms 20
Aspects of Virulence: Antibiotic Resistance 21
Conclusion 22
References 23
The Process of Antibiotic Prescribing: Can It Be Changed? 28
Introduction 28
Use of Antibiotics 28
Medical Professionals 29
Patient Knowledge and Behavior 31
Organization of Patient Care 32
Sociocultural Environment 32
Socioeconomic Environment: The Role of Industry 34
Conclusions 35
References 36
Cultural and Socioeconomic Determinants of Antibiotic Use 39
Background 39
Potential Determinants Explaining Disparities in Antibiotic Use 39
The Cultural Perspective 43
The Socioeconomic Perspective 44
The Health Economic and Regulatory Perspective 46
Summary 47
References 47
Electronic Prescribing 51
Foreword 51
Antibiotic Decision-Making 52
The Place for Electronic Antibiotic Prescribing 54
Assembling PatientsÌ Data 54
Use of Local Data 55
Computation of Large Matrices 55
Bringing Evidence-Based Medicine to Clinicians 55
Pattern Recognition Alerts 56
ÏWatchdogÓ Alerts 56
Reinforcement of Guidelines 56
Testing of Antibiotic Decision Support Systems 56
Who Should Be Randomized? 57
What Are the Outcomes We Should Measure? 57
Differentiating between the SystemÌs Performance and User Interactions 57
External Validity 58
Ethical Considerations 58
Existing Experience: Review of the Literature 58
Methods 58
Results 60
The TREAT System 67
Lessons Learned and the Future 72
References 73
Prevalence Surveys of Antimicrobial Use in Hospitals: Purpose, Practicalities, and Pitfalls 78
Introduction 78
Why Measure Antibiotic Use in Hospitals? 78
Why Measure the Quality of Prescribing? 79
The Prescribing Pathway 79
What Data Should Be Collected during an Antibiotic Prevalence Survey? 81
Coordinating an Antibiotic Point Prevalence Survey 82
Data Analysis 85
Interpretation and Limitations of Data 85
Feedback of Data 86
CostÒBenefit Assessment of Antimicrobial Prevalence Surveys 87
Conclusions 88
References 88
Antibiotic Use in Hospitals in the United States SCOPE- MMIT Antimicrobial Surveillance Network 91
Introduction 91
SCOPE-MMIT Antimicrobial Monitoring Network 91
Measurement of Antibiotic Use 92
Hospital and Patient Demographics 92
Antimicrobial Use 92
Antimicrobial Restriction Policies 95
Antibiotic Costs 97
Conclusion 97
References 98
New Hospital Initiatives in Fighting Resistance 100
Summary 100
Introduction 100
Microbiological Evidence of Infection 101
Identification of the Organism(s) 102
Nucleic Acid Extraction 103
Amplification and Detection of Pathogens 104
Genomics 105
Proteomics 105
Antibiotic Susceptibility Pattern of the Organism(s) 106
MRSA 106
Other Resistant Organisms 107
Local Knowledge of the Epidemiology of Resistance 107
Identification of Virulence Factors 108
Optimization of Local Prescribing Behavior 109
Initiatives to Support and Influence the Prescriber 109
Methods to Standardize Prescribing Practice in Hospitals 110
Executive Leadership and Management Engagement 112
Systems of Monitoring and Feedback 113
Maximizing the Role of Pharmacists 114
Understanding the Blocks 115
Incentives for Clinicians 116
Conclusion 116
References 117
Antimicrobial Resistance: Preventable or Inevitable? 120
Introduction 120
Antimicrobial Resistance in the Community and Hospitals 121
Urinary Tract Infections 121
Respiratory Tract Infections 123
Multidrug-Resistant Mycobacterium tuberculosis 126
Methicillin-Resistant Staphylococcus aureus 126
Pseudomonas aeruginosa 128
Acinetobacter baumannii 129
Vancomycin-Resistant Enterococci 130
Rational Use of Antimicrobials 130
References 131
Fighting Antimicrobial Resistance in the Mediterranean Region 141
Introduction 141
Regional Epidemiology 141
Antibiotic Use 146
Antibiotic Policy Development 148
Prevention and Control of Multiresistant Infections 150
Conclusion 152
References 153
Cystic FibrosisÛCoping with Resistance 155
Cystic Fibrosis: Chronic Lung Infection with P. aeruginosa 155
Conventional Mechanisms of Resistance Resistance to - Lactam Antibiotics 157
Resistance to Fluoroquinolones 157
Resistance to Aminoglycosides 158
Resistance to Polymyxins 159
Nonmucoid Isolates Are More Resistant Than Mucoid Isolates in Planktonic Growth 159
Biofilm Mode of Growth and Antibiotic Resistance Mechanisms 160
The Response of P. aeruginosa Biofilms to -Lactams 161
The Response of P. aeruginosa Biofilms to Fluoroquinolones 166
The Response of P. aeruginosa Biofilms to Aminoglycosides 168
The Response of P. aeruginosa Biofilms to Polymyxins 170
Oxidative Stress in the CF Lung and Hypermutability 171
How to Cope with Resistant P. aeruginosa in the CF Lung Preventing Biofilm Formation and Suppressing Biofilm Infection 171
Preventing Infection with P. aeruginosa by Cohorting Infected and Noninfected CF Patients 172
Coping with Biofilm Related Resistance Mechanisms 172
Coping with Conventional Resistance Mechanisms 173
Coping with Oxidative Stress 174
References 174
Community-Acquired PneumoniaÛ Back toBasics 181
Background 181
Etiology 182
Identification of Causative Pathogens 183
Clinical, Radiological, and Laboratory Features 183
Microbiology and Serology 183
Urinary Antigen Testing 184
DNA Detection 184
Therapy Microorganisms and Antibiotic Resistance 184
Recommended Treatment 185
Length of Treatment 189
Prevention 189
Conclusions 190
References 191
Hospital-Acquired Pneumonia: Diagnostic and Treatment Options 198
Introduction 198
Epidemiology 198
Diagnosis 199
Microbiological Diagnosis 200
General Approach to Antibiotic Treatment of HAP 200
Empiric Treatment of Ventilator-Associated Pneumonia 201
Empiric Treatment of Group I VAP 201
Empiric Treatment of Group II VAP 202
Appropriate Antibiotic Selection and Adequate Dosing 202
Local Instillation and Aerosolized Antibiotics 203
Combination versus Monotherapy 203
Full-Length Treatment for VAP 204
Special Situations 204
1. P. aeruginosa 204
2. Acinetobacter spp. 205
3. Extended-Spectrum ÒLactamase-Producing (ESBL) Enterobacteriaceae 205
4. Methicillin-Resistant Staphylococcus aureus (MRSA) 205
Antibiotic Heterogeneity and Antibiotic Cycling 206
Response to Therapy Modification of Empiric Antibiotic Regimens 206
Defining the Normal Pattern of Resolution 206
Reasons for Deterioration or Nonresolution 207
Evaluation of the Nonresponding Patient 208
References 209
Optimizing Antimicrobial Chemotherapy in the ICUÛA Review 213
Abstract 213
Introduction 213
Trends in Sepsis and Mortality 214
Differences in Susceptibility to Infection and Types of Infection 214
Multiresistant Infections 214
Trends in Antibiotic Susceptibility of ICU Pathogens 215
Principles of Antibiotic Treatment The Importance of Early Treatment 215
The Pharmacodynamics of Antibiotic Treatment 216
Combination Therapy 217
The Role of the Microbiology Laboratory 218
Antibiotic Prescribing Policies 220
Selective Digestive Decontamination and Antibiotic Cycling 220
Empiric Treatment Choices for Multiresistant Organisms 221
References 222
Risk Assessment for Methicillin- Resistant Staphylococcus aureus 227
Foreword 227
Risk Assessment for MRSA at Hospital Admission 228
Risk Assessment for MRSA During Hospitalization 232
Risk Assessment for Mortality Caused by MRSA 234
Comments 235
References 236
What Do We Do with Methicillin- Resistant Staphylococcus aureus in Surgery? 241
Epidemiology of MRSA: Trends Relevant to Surgical Patients 241
Risk Factors for MRSA Infection in Surgical Patients 242
Physiopathology of MRSA Infections in Surgical Patients 243
Burden of MRSA Infection in Surgical Patients 243
Prevention 244
Preoperative Use of Topical Antibiotics Active Against MRSA 245
Systemic Perioperative Prophylaxis with Antibiotic Active Against MRSA 246
Infection Control Measures 249
Policies for Appropriate Use of Antibiotics 250
References 250
Control of Healthcare-Associated Methicillin- Resistant Staphylococcus aureus 256
Introduction 256
Mechanism of Resistance and Molecular Background of HA- MRSA 258
Treatment of MRSA Infections 259
The Epidemiology of MRSA 260
Prevention and Control of Infection 261
Antibiotic Control 261
Infection Control 262
Conclusion and Recommendation 267
References 268
Index 273