a ntimicrobial s tewardship what’s in it for you! paul pottinger, md, dtm&h director, uwmc...
TRANSCRIPT
ANTIMICROBIAL STEWARDSHIP
What’s In It For YOU!Paul Pottinger, MD, DTM&H
Director, UWMC Antimicrobial Stewardship Program
February 11, 2014
Show of Hands…
1. Have you ever taken antibiotics?
2. Whose life was saved by antibiotics?
• 20%
• > 300 mil
• 50%
• 50%
Harsh Realities in USA
• Abx for Humans:
• Abx Courses / yr:
• Abx for Outpatients:
• Abx Appropriate:
An InconvenientTruth?
• 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
Physicians are not happy about any of this.
“How should medical science respond?”
• Public Policy Makers
Key Players Must Respond!
• Public Policy Makers
GAIN act now law!
Key Players Must Respond!
• Public Policy Makers
Key Players Must Respond!
• Public Policy Makers
• Researchers
Key Players Must Respond!
New Medications… and Beyond!
• 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?
• Public Policy Makers
• Researchers
• Clinicians
Key Players Must Respond!
Clinical Infectious Diseases 2013;57(5):631–8
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”
What’s in a Name?
“Antimicrobial Control”
“Antimicrobial Management”
What’s in a Name?
“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.
“Spiraling Empiricism”Broad-Spectru
m Coverag
eMDRO Selectio
n
Diagnostic
Uncertainty
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
Newer, Fancier, Pricier ≠ Better!
Linezolid TMP/SMX
For MRSA SSTI….
VAP
CABSI
CAUTI
Pottinger’s Axiom: Time + Tube = Trouble
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
• Public Policy Makers
• Researchers
• Clinicians
• Patients
Key Players Must Respond!
If you’re not angry—or alarmed—you have not been paying attention.
“What can I DO?”
P2I WANT YOU…
To help bring antibiotic useunder control!
P2
Become an antibiotic steward!
Take Care of Each Other!
Abx Stewardship: Conclusions
“Our vs. Their Genes” • Few new abx coming…
• Abx resistance is our fault…
• Fixing this is our responsibility…
• Respect needs & patterns globally
• Together, we can do it!
Brains
THANK YOU