Some antibiotic stewardship stories and big challenges in education at #ASMMicrobe2016

By Oliver J Dyar

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This post includes talks from two sessions at the 2016 ASM Microbe meeting: Antimicrobial stewardship II and Big challenges in pre-clinical med student microbiology education.

 

Antimicrobial stewardship II

Highlights from this broad session include:

– Impact of an Antimicrobial Stewardship Program on Antibiotic Resistance: A Patient-Level Perspective. Winnie Lee from Singapore described the challenges of evaluating the outcomes of stewardship programmes by investigating resistance trends among all clinical samples. An alternative approach is to look at outcomes from a patient-level perspective. In Singapore General Hospital, acceptance of recommendations from the antimicrobial stewardship team led to fewer subsequent infections by MDR organisms (9% vs. 2%), and significantly shorter durations of antibiotic therapy and hospital stay.

– Improved Antibiotic Stewardship and Treatment of Staphyloccocus aureus Bacteremia through Implementation of a Nucleic Acid Microarray Identification System and Lean Process Management. Joshua Eby explained how in Virgina they combined a simplified protocol for mandatory ID consultation, together with the use of an nucleic acid microarray for detecting Staphylococcus aureus bacteremia. This led to a large reduction in the time to initiation of first line antibiotic (or appropriately chosen second line antibiotic) from a mean of 26.3 to 8.3 hours.

– Microbiology Plate Rounds: Antimicrobial Stewardship (AS) and Clinical Microbiology Laboratory (CML) Work Together to Enhance Timely, Clinically Relevant Patient Care. Shawn MacVane presented an idea used in South Carolina to bridge the gap that often exists between stewardship teams and the microbiology laboratory. A daily ‘plate round’ is run in the microbiology laboratory, and members of the stewardship team are invited to attend, as well as technical staff, pharmacists and trainees. Over the course of 19 plate rounds in November 2015, a total of 85 interventions were suggested by participants. These included a mixture of clinical interventions (for example, recognising that the microbiology lab should contact the patient’s admitting team; changing antimicrobial therapy), and also laboratory interventions (for example, avoiding unnecessary culture workup).

– The results of Student-PREPARE, a study of medical student preparedness organised by ESGAP were also presented at this session (European results, by Oliver Dyar) and in Antimicrobial stewardship I (Slovenian results, by Bojana Beovic).

 

Big challenges in pre-clinical med student microbiology education

This session featured four speakers addressing the current and emerging challenges in microbiology education in the US, but with many lessons that are relevant for other settings. Michael Schmidt from South Carolina spoke about three major topics that are largely missing in pre-clinical education: antibiotic stewardship, the microbiome, and infection control. These are rapidly developing areas in science, but education is lagging behind. A common theme throughout all of the talks was the benefit for working towards closer integration between pre-clinical and clinical parts of the curricula, particularly for topics such as stewardship. As an example, the concept of antibiotic selection pressure is usually taught in pre-clinical education, and can be a good opportunity to introduce the role of stewardship in minimizing overuse of antibiotics. Elizabeth Joyce and Peter Chin-Hong from California introduced the idea of moving beyond horizontal and vertical integration within curricula, to spiral integration: revisiting topics and gradually building complexity and meaning, an approach that draws on theories of how adults learn most effectively.

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