ID specialists on World Antimicrobial Awareness Week 2020 - Firstline

World Antimicrobial Awareness Week 2020

Firstline asked infectious disease experts to share gems of wisdom for World Antimicrobial Awareness Week. This is what they had to say.

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Antimicrobial stewardship is more about knowing which questions to ask and working with others, than having all the answers yourself.
Review antimicrobials daily, adjust treatment based upon microbiological results and optimize spectrum, duration and dose according to local evidence based guidance.
Patients with a true (immediate) penicillin allergy can still safely receive cefazolin for surgical prophylaxis.
Durations of therapy for uncomplicated pneumonia, sinusitis, urinary tract infections should all be less than a week.
Over 10% of people think they are Penicillin allergic – when only 1% are actually allergic. Ask questions and save antibiotics.
Fever doesn’t always require antimicrobials or change in therapy but always try to determine the cause of fever.
Shorter is Better! Short-course antibiotic therapies have been shown to be just as effective as longer courses of therapy for a variety of acute bacterial infections.
Don’t collect urine for culture in adults with no urinary tract symptoms unless they are pregnant or undergoing an invasive urological procedure.
If your patient remains febrile despite antibiotics, switching to a broader spectrum agent is rarely the right solution. Rather look for complications and non-infectious causes.
We all have a role to play in antimicrobial stewardship. Clearly stating the indication and duration or reassessment date will help keep everyone on the same page.
Knowing when not to prescribe antibiotics is often as important as knowing when to prescribe them.
Infection prevention is better than treatment, and good living conditions and management are best for animal health, animal welfare and antimicrobial resistance.
It is sometimes harder to do nothing. Think twice before prescribing an antibiotic.
Antimicrobial Stewardship Programs start by understanding patients-bugs-antimicrobials and having a strong interdisciplinary team.
Patients with SARS-CoV2 infections need proper assessment before receiving antibiotic treatment.
Treat the patient not the numbers… and (almost) never treat asymptomatic bacteriuria.
When it comes to antimicrobial stewardship, it's interdisciplinary teamwork that makes the dream work... and when it works, patients win!
Antibiotics shouldn’t be used as a crutch for poor animal management.
Starting antibiotics can be easy, but once that horse has left the barn it can be a big challenge to corral it later. Start smart, then narrow.
Source control is one of the best ways to achieve Antimicrobial Stewardship.
When selecting empiric antibiotics, identify patient specific risk factors for MDROs to limit unnecessary broad spectrum antibiotics.
Antimicrobial stewardship programs “steer the ship“ but all hands on deck needed to fight antimicrobial resistance.
Get friendly with your surgeons! Good source control can significantly decrease durations of antibiotics and prevent resistance. Drains do not promote resistance.
Foul smelling/cloudy urine is not a sign of infection. Avoid testing in the absence of true urinary tract infection symptoms.
Antibiotic resistance impacts all of our patients. Prescribe antibiotics carefully and responsibly.
With appropriate oral antibiotics, there is no difference in treatment success or mortality compared to IV.
The COVID-19 pandemic is raging but let's not forget the longer standing 'pandemic' of antibiotic overuse and resistance.
Count each day of antibiotic therapy carefully, because every unnecessary dose avoided means less risk to the patient.
Less antimicrobials in, more Foley catheters out.
After 3 days, review the antibiotic prescription for necessity, bug-drug mismatch, duration and narrow the spectrum when possible.
Patients with a label of penicillin allergy should have an appropriate assessment before being prescribed non-beta lactam antibiotics.
In non-pregnant adults, don't expect the urine to be sterile. Bacteriuria without symptoms may actually be protective in these patients.
Antibiotics have the potential to cause severe side-effects. Please use them wisely and decrease C. difficile infections.
Use transitions of care as a stewardship opportunity. Leaving the ICU? Discharged home? Re-evaluate if that abx is still needed!
Antibiotics are not anxiolytics. Treat your patient, not your own anxiety.
Post-operative antibiotic prophylaxis is not needed after skin closure for surgeries considered clean or clean-contaminated.
It's important to tailor antibiotic prescription to the individual patient, and not just the bug.
The most effective empiric treatment is based on local resistance trends.
Consider patient-specific factors, e.g. recent antimicrobials & microbiological history, when selecting empiric antimicrobials. Resistance is often predictable.
Antibiotic exposure remains the single most important risk factor for the development of Clostridiodes difficile infection.
Limit antibiotics to the shortest duration indicated. Prolonged antibiotics increases antibiotic resistance and side effects.
Bactrim is unreliable for infections caused by S. pyogenes.
#WAAW is a perfect time to remind all healthcare workers to be antimicrobial stewards. Let's all work together to protect our precious antibiotic arsenal.
Now is the time to focus on using guidelines to choose antibiotics only for those who truly need them and limiting use to the shortest duration possible.
One Health - One Globe - One Stewardship. The intricate interconnected circle of humans, animals, and the environment. Keep it safe and secure. Choose antibiotics wisely.
As I learned during my training from my ASP MD, there is no post antibiotic stewardship effect. Antimicrobial Stewardship should be performed at least daily.

See 2021 WAAW here