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SUPERBUGS: STRUMENTI DI INTERVENTO NELL’ERA POST-ANTIBIOTICA

SUPERBUGS: STRUMENTI DI INTERVENTO NELL’ERA POST-ANTIBIOTICA. Nicola Petrosillo Dipartimento Clinico e di Ricerca in Malattie Infettive INMI «L. Spallanzani», IRCCS - Roma. Emerging Threats in Healthcare. MDR organisms in the healthcare setting: from ESKAPE to ESCAPE

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SUPERBUGS: STRUMENTI DI INTERVENTO NELL’ERA POST-ANTIBIOTICA

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  1. SUPERBUGS: STRUMENTI DI INTERVENTO NELL’ERA POST-ANTIBIOTICA Nicola Petrosillo Dipartimento Clinico e di Ricerca in Malattie Infettive INMI «L. Spallanzani», IRCCS - Roma

  2. Emerging Threats in Healthcare

  3. MDR organisms in the healthcare setting: from ESKAPE to ESCAPE • We are currently facing new microbiological, infection control and clinical issues, and the epidemiologic variations observed in the last years highlighted the need of a change from the initial proposed acronym: • “ESKAPE” “ESCAPE” • E. faeciumE. faecium • S. aureusS. aureus • K. pneumoniae C. difficile • A. baumanniiA. baumannii • P. aeruginosa P. aeruginosa • Enterobacter species Enterobacteriaceae

  4. Euro Surveill 2013; 18:46

  5. ECDC/EMA: European Annual Cost Estimates of Five Top MDRB

  6. Hospital and Societal Costs of Antimicrobial-Resistant Infections (ARIs) An economic analysis of the Chicago Antimicrobial Resistant Project dataset: 188 / 1391 patients (13.5%) with ARI Roberts RR et al. Clin Infect Dis 2009;49:1175-84.

  7. Lesssurgery for the risk of AMR • Caesareansectionscontributeabout 2% to world GDP • Joint replacementsaddabout 0.65% • Organtransplantaddabout 0.1% • These are just a small number of the areas in modern medicine thatriskbeingunderminedifwe do nothaveeffectiveantibiotics in the future • Concerns for internationaltravels lesstradeaffectingmainlydeveloppingcountries

  8. Estimates of Preventable Infections, Deaths, and Costs

  9. Antimicrobial Stewardship Programs • ASPs are designed • to optimize antimicrobial therapy, • 1-to improve patients’ outcomes, • 2-ensure cost-effective therapy and • 3-reduce adverse effects associated with antimicrobial use, including antimicrobial resistance and C difficile occurrence

  10. INFECTION CONTROL AND ANTIBIOTIC STEWARDSHIP • Although the responsibilities of antimicrobial stewardship programs and infection control departments are different, collaboration between these groups is essential in • promoting optimal outcomes, • providing cost-effective care, • reducing the development of resistance, and • preventing the spread of infection.

  11. Infection control departments must rely on stewardship programs to help minimize excessive antibiotic exposure, which ultimately decreases the level of risk that patients face with regard to acquiring infections due to multidrug-resistant organisms.

  12. Antimicrobial stewardship programs rely on good infection-control practices, in a complementary fashion, to minimize the patient-to-patient spread of multidrug resistant bacteria. • Poor infection control practices can lead to increasing number of patients with multidrug-resistant infections, which leads to a downward spiral of increased utilization of broad-spectrum antibiotics and the further development of resistance.

  13. Additionally, antimicrobialstewardshipprograms and infection control practitionersare wellpositioned to identify and improvepatientoutcomeslinked to a specificdiseasebecausetheyalready target patients with specificinfections, diseasestates, or patientsreceivingcertainantimicrobials.

  14. Interactionsbetween ASP and IC professionals • Drug-based antimicrobial stewardship • Disease-based antimicrobial stewardship and multidisciplinary bundle • Device-associated Infection Prevention • Barriers to implementation and maintenance of stewardship programs • Making a business case for antimicrobial stewardship • Measuring the impact of the Program

  15. Fromcompetenceto meta-competence Thera-py Antimicrobial Stewardship (A-Teams) ID-doctor Intensivist Pharmacist Theragnostic-concept Clin. Microbiol- infection prevention Clin. Microbiol.ABS PHS Infection Control Practitioner Moleculair Medisch Microbioloog Infection Prevention Stewardship Dia-gnosticStewardship Dik et al. 2015 Future Microbiology Courtesy Prof. A Friedrich

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