Slide 1: Educational purposes disclaimer
This presentation is offered for educational purposes only, intended to serve as continuing medical education for health care professionals. The content of the presentation represents the views and opinions of the original creators of such content and does not necessarily represent the views or opin
Slide 2: Principles of AMR stewardship and impact of adherence
A:CARE CONGRESS Principles of Anti-Microbial Resistance (AMR) stewardship and impact of adherence Prof. Evangelos J. Giamarellos-Bourboulis, MD, PhD, FISAC Professor of Internal Medicine; Director: MsC program of Infectious Diseases; National and Kapodistrian University of Athens President: European
Slide 3: Conflict of Interest Disclosure
CONFLICT OF INTEREST DISCLOSURE Honoraria (paid to the University of Athens) from Abbott CH, Brahms ThermoFisher GmbH Germany, GSK and Sobi Consultant for Fab’nTech, InflaRx GmbH, UCB and Xbiotech Inc Independent educational grants (paid to the University of Athens) from AbbVie USA, InflaRx GmbH, No
Slide 4: Question 1
Question 1 WHY, IN YOUR OPINION, DOES ANTIMICROBIAL STEWARDSHIP MATTER? Prevents mortality of the elderly Prevents infections by difficult-to- treat microorganisms Prevents adverse effects from the use of antimicrobials All the above To participate in polling please exit full screen mode GLO2208859
Slide 5: Antimicrobial Stewardship Definition
ANTIMICROBIAL STEWARDSHIP DEFINITION A SYSTEMATIC APPROACH TO PROMOTING AND MONITORING JUDICIOUS USE OF ANTIMICROBIALS TO PRESERVE THEIR FUTURE EFFECTIVENESS BY ADMINISTERING ANTIMICROBIALS To the right At the right patient time Appropriately Via the right For the right route duration Antimicrobial
Slide 6: Keep Antimicrobials Alive
Education programs Encourage and maintain good adherence to rationally prescribed antimicrobial KEEP ANTIMICROBIALS ALIVE Audits in the general Stop antimicrobials when ward given for too long GLO2208859 | Nov-21 | 6
Slide 7: Question 2
Question 2 CASE 1: A MAN OF 75 YEARS IS HOSPITALIZED FOR PNEUMONIA FOR WHICH HE RECEIVES PIPERACILLIN/TAZOBACTAM FOR 25 DAYS. HE IS DISCHARGED ON DAY 26 AND AFTER 25 DAYS HE IS ADMITTED WITH FEVER, HYPOTENSION AND DIARRHEA. THE PATIENT IS STARTED ON MEROPENEM WITH NO RESPONSE. THE PATIENT DIES AFTER
Slide 8: Why to use biomarkers to guide early stop of antibiotics?
WHY TO USE BIOMARKERS TO GUIDE EARLY STOP OF ANTIBIOTICS? Less exposure to antibiotics Resistant human flora Decrease of cost Super-infections by resistant pathogens Infections by Clostridioides difficile Decrease of mortality? Kyriazopoulou E, Poulakou G, Giamarellos-Bourboulis EJ. Biom
Slide 9: PROGRESS Trial: A Major Paradigm
PROGRESS TRIAL: A MAJOR PARADIGM PRIMARY ENDPOINT STOP ΑΝΤΙMICROBIALS AT PHYSICIAN’S DΙSCRΕTION ENROLLMENT FOLLOW - UP STOP ANTIMICROBIALS PCT <0.5ng/ml OR >80% a a a DECREASE Stool Stool Stool Stool a. Daily repeat until cut-off achieved d5 d7 d28 d180 Kyriazopoulou E, et al. Procalcitonin to Reduc
Slide 10: PROGRESS: Primary Study Endpoint
PROGRESS*: PRIMARY STUDY ENDPOINT The rate of INFECTION-ASSOCIATED ADVERSE EVENTS at 6 months Composite by ANY of: C. difficile Infection and/or MDRO Infection and/or C. difficile or MDRO infection- NO. AT RISK associated death Standard-of-care 131 87 81 78 77 76 76 * PROcalcitonin-Guided antimicrob
Slide 11: Question 3
Question 3 CASE 2: A WOMAN OF 30 YEARS IS SUFFERING FROM RELAPSING EPISODES OF CYSTITIS. SHE IS ADVISED TO RECEIVE ONE PILL OF NITROFURANTOIN DAILY BEFORE NIGHT SLEEP FOR ONE YEAR. SUDDENLY THE PATIENT HAS FEVER OF 400C AND RIGOR. WHAT WENT WRONG? She forgot to ger her pill because of overwhelming a
Slide 12: Antimicrobials for Relapsing Cystitis
ANTIMICROBIALS FOR RELAPSING CYSTITIS Chemoprophylaxis <6 months (n= 59) Success rate Trimethoprim/sulfamethoxazole 80/400 mg qd 20.0% Norfloxacin 100 mg qd 42.9% p: 0.060 Nitrofurantoin 50 mg qd 59.1% Chemoprophylaxis ≥6 months (n= 122) Success rate Trimethoprim/sulfamethoxazole 80/400 mg qd 82.8%
Slide 13: Patient-Related Factors of Adherence
ANTIMICROBIAL STEWARDSHIP: PATIENT-RELATED FACTORS OF ADHERENCE SYSTEMATIC REVIEW (87 STUDIES FROM 33 COUNTRIES) OF PATIENT-RELATED DETERMINANTS OF ANTIBIOTIC USE: 1 Demographic and socio-economic characteristics 2 Patient–doctor interactions 3 Treatment characteristics (e.g. administration frequenc
Slide 14: Patient Adherence in Pharyngitis
ANTIMICROBIAL STEWARDSHIP: PATIENT ADHERENCE IN PHARYNGITIS Medication Event Monitoring System from the Pharmacy (n= 481 patients) Level of adherence 100 80 % of patients 60 40 20 0 Excellent Acceptable over time Declining over time Somewhat adherent Unacceptable Llor C, et al. A study of adherence
Slide 15: The Importance of Adherence
THE IMPORTANCE OF ADHERENCE Non-adherence often affects the outcome of treatment1 Exposing microbes to sub-therapeutic doses of medication drives resistance2 MOST COMMON RISK FACTORS FOR NON-ADHERENCE3 INFECTIONS WITH FREQUENT NON-ADHERENCE1 1 Younger age 1 HIV infection 2 Low income 2 Tuberculosis
Slide 16: The Importance of the Dialog
THE IMPORTANCE OF THE DIALOG PATIENT–DOCTOR INTERACTIONS THAT HAD AN IMPACT ON ADHERENCE INCLUDE: Clearly understanding the advice provided by the doctor (including receiving written as well as verbal instructions) Not feeling ignored by the doctor Feeling a sense of control over one’s own treatment
Slide 17: Antimicrobial Stewardship: Main Conclusions
ANTIMICROBIAL STEWARDSHIP: MAIN CONCLUSIONS PHYSICIAN (PRESCRIBER) PATIENT (ADHERENCE) • Molecular diagnosis • Feedback to the physician • Use of biomarkers (initiate • Calm the fear for need of treatment, stop treatment) antimicrobials for flu • CONTINUOUSLY EDUCATE • EXPLAIN why adherence is • Sup