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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  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
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
  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.
  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.
  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.
  resistance impacts all of our patients. Prescribe antibiotics carefully and
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.
  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.
  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
The most effective
  empiric treatment is based on local resistance trends.
  patient-specific factors, e.g. recent antimicrobials & microbiological
  history, when selecting empiric antimicrobials. Resistance is often
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