![Page 1: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/1.jpg)
Antibiotics
Tamar Barlam
Infectious Disease
Director, Antimicrobial Stewardship
![Page 2: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/2.jpg)
Why is antibiotic choice important?
Safe, broad-spectrum antibiotics are readily available
One can easily cover most common infections with excellent therapeutic results
So what’s the big deal?
![Page 3: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/3.jpg)
A Changing Landscape forNumbers of Approved Antibacterial Agents
Bars represent number of new antimicrobial agents approved by the FDA during the period listed.
00
2
4
6
8
10
12
14
16
18
Nu
mb
er o
f ag
ents
ap
pro
ved
1983-87 1988-92 1993-97 1998-02 2003-05 2008
Infectious Diseases Society of America. Bad Bugs, No Drugs. July 2004; Spellberg B et al. Clin Infect Dis. 2004;38:1279-1286;New antimicrobial agents. Antimicrob Agents Chemother. 2006;50:1912
Resistan
ce
![Page 4: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/4.jpg)
Between 1962 and 2000, no major classes of antibiotics were introduced
Fischbach MA and Walsh CT Science 2009
![Page 5: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/5.jpg)
Antibiotic Resistance
Antimicrobial-resistant infections can cause worse patient outcomes, longer hospital stays, and higher mortality rates than similar infections with antibiotic-susceptible bacteria.
Total costs related to AR infections are estimated as high as $30 billion.
Inappropriate antibiotic use is believed to be the major contributor to the development and spread of AR bacteria. Studies have demonstrated approximately 30 to 50% of
antibiotic treatments are inappropriate.
![Page 6: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/6.jpg)
Resistant StrainsRare
xx
Resistant Strains Dominant
Antimicrobial Exposure
xxxx
xx
xx
xx
Selection for antimicrobial-resistant Strains
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
![Page 7: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/7.jpg)
Choosing an Antibiotic
What is wrong with the patient? Is it an infection? Is it bacterial? How sick is the patient? Host factors that might influence likely
pathogens: social history, age, residence, comorbid conditions
Host factors that might influence drug choice: allergy, pregnancy, renal/liver function
![Page 8: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/8.jpg)
Attributes of the drug
What is its spectrum? Gram positive or gram negative? Aerobic or anaerobic or both?
Does it reach adequate levels at site of infection?
Bacteriostatic or bacteriocidal? Endocarditis Meningitis Osteomyelitis
![Page 9: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/9.jpg)
How are they different?
Cefazolin Ceftriaxone Cefepime Ampicillin-sulbactam Ertapenem Levofloxacin Ciprofloxacin
Ceftriaxone Cefepime Piperacillin-tazobactam Piperacillin-tazobactam Meropenem Ciprofloxacin Cefepime
![Page 10: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/10.jpg)
Case #1
54 yo female with poorly controlled diabetes comes to the ED with a buttock abscess with surrounding erythema. The abscess was I&D’d and material sent for culture.
![Page 11: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/11.jpg)
Case #1
Patient was placed on clindamycin and discharged home.
![Page 12: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/12.jpg)
Case #1
![Page 13: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/13.jpg)
Case #1 Inducible macrolide resistance.
Encoded by plasmid-borne gene erm.
Constitutive – all test resistant Inducible – clindamycin can
test susceptible
![Page 14: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/14.jpg)
Bacteria Isolated from Culture of Abscess Material, Deep Tissue Specimens, or Blood.
Jenkins T C et al. Clin Infect Dis. 2010;51:895-903
© 2010 by the Infectious Diseases Society of America
![Page 15: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/15.jpg)
Case #2
23 yo healthy male with tibial fracture after MVA. ORIF performed and patient was discharged after an uneventful hospital course. Pain persisted and after six weeks, there was complete non-union. One month later, a small pustule formed and drained purulent material. Patient was seen by ortho and taken back to OR.
What is the patient’s diagnosis? Treatment?
![Page 16: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/16.jpg)
Case #2
![Page 17: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/17.jpg)
Case #2
What if these were the culture results?
![Page 18: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/18.jpg)
Case #3
47 yo active IVDU, HCV positive, presents with severe left arm pain and swelling. The patient had injected heroin into the veins of that arm 1 day prior.
On the morning of admission, he had severe bilateral pleuritic chest pain
![Page 19: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/19.jpg)
Case #3
Rest of exam: T103 Other VSS II/VI SEM at LSB, decreased breath sounds
R>L base, rales bilaterally No HSM
WBC 18,000 w/ 26% B; H/H 13/40, plts 300K other labs wnl
![Page 20: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/20.jpg)
Case #3
![Page 21: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/21.jpg)
Case #3
Describe what the patient likely has. What would you do next? Antibiotics?
![Page 22: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/22.jpg)
Case #3
![Page 23: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/23.jpg)
Case #3
Antibiotic? Duration?
![Page 24: Antibiotics Tamar Barlam Infectious Disease Director, Antimicrobial Stewardship](https://reader035.vdocument.in/reader035/viewer/2022062421/56649e685503460f94b64223/html5/thumbnails/24.jpg)
Case #3
What if patient if this was his isolate: