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Antimicrobial Stewardship What’s In It For YOU!. Paul Pottinger, MD, DTM&H Director, UWMC Antimicrobial Stewardship Program February 11, 2014. Show of Hands…. Have you ever taken antibiotics? Whose life was saved by antibiotics?. Harsh Realities in USA. Abx for Humans:

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antimicrobial stewardship what s in it for you

Antimicrobial StewardshipWhat’s In It For YOU!

Paul Pottinger, MD, DTM&H

Director, UWMC Antimicrobial Stewardship Program

February 11, 2014

show of hands
Show of Hands…

Have you ever taken antibiotics?

Whose life was saved by antibiotics?

harsh realities in usa
Harsh Realities in USA
  • Abx for Humans:
  • Abx Courses / yr:
  • Abx for Outpatients:
  • Abx Appropriate:
  • 20%
  • > 300 mil
  • 50%
  • 50%
brutal truths
Brutal Truths
  • Abx Resistance is on the rise (and it’s our fault).
  • Abx discovery pipeline is all but dry.
  • We must control our destiny.
slide6

Physicians are not happy about any of this.

“How should medical science respond?”

key players must respond
Key Players Must Respond!
  • Public Policy Makers
slide8

Key Players Must Respond!

  • Public Policy Makers

GAIN act now law!

key players must respond1
Key Players Must Respond!
  • Public Policy Makers
slide10

Key Players Must Respond!

  • Public Policy Makers
  • Researchers

New Medications… and Beyond!

slide11

The Future: Pro-Biotics?

  • Lactobacillus crispatusis 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)

Stapleton CID 2011

slide12

Immunizations for Bad Bugs?

  • Limitation: Normal Flora  Pathogen.
  • May still be feasible versus high-profile non-symbionts.
slide14

Study Limitations

  • Animal model.
  • Limited repertoire of Staph isolates.
  • PNA examined, not SSTI or BSI.
  • Potential of MRSA Vaccine
  • Extraordinary potential benefits… Unanticipated consequences?
slide15

Key Players Must Respond!

  • Public Policy Makers
  • Researchers
  • Clinicians
abx training at uw jhu miami
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!
slide19

What’s in a Name?

“Antimicrobial Control”

slide20

What’s in a Name?

“Antimicrobial Control”

“Antimicrobial Management”

slide21

What’s in a Name?

“Antimicrobial Control”

“Antimicrobial Management”

“Antimicrobial Stewardship”

Stew·ard (noun): A person whose responsibility it is to take care of something.

slide27

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

12 Break the chain

11 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 Effectively

Prevent Infections

12 Steps to Prevent Antimicrobial Resistance:Hospitalized Adults

slide28

Newer, Fancier, Pricier ≠ Better!

Linezolid

TMP/SMX

For MRSA SSTI….

slide29

Pottinger’s Axiom:

Time + Tube = Trouble

CABSI

VAP

CAUTI

slide31

Prevent Infection

  • “Clean Your *&^%@! Hands”
  • Hand Hygiene Remains Cornerstone of IC
  • Biggest Cost:Benefit Ratio Around
  • Patients Will Thank (or Chastise) You!
  • Obey Precaution Placards

IgnacSemmelweis

(1818-65)

slide33

Key Players Must Respond!

  • Public Policy Makers
  • Researchers
  • Clinicians
  • Patients
slide34

If you’re not angry—or alarmed—you have not been paying attention.

“What can I DO?”

slide35

I WANT YOU…

To help bring antibiotic use

under control!

P2

slide40

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