Chapter
Introduction by Evelina Tacconelli
Section A: The Global Picture of Antimicrobial Use and Resistance
Chapter 1: The Global Crisis of Antimicrobial Resistance
Prevention of Access to Target
Target Modification of the Antibiotic by Genetic Mutation or Posttranslational Modification
Direct Modification of Antibiotics
Degradation of Antibiotics by Enzyme Hydrolysis
Inactivation of Antibiotics by Transfer of a Chemical Group
Chapter 2: Antimicrobial Stewardship: Efficacy and Implementation of Strategies to Address Antimicrobial Overuse and Resi ...
The Relationship Between Antibiotic Use and Drug Resistance
The Evidence Supporting Antimicrobial Stewardship Strategies
Choosing a Stewardship Strategy
Implementation of an ASP in Nontertiary Care Settings
Building the Stewardship Team
Messaging the Importance of antimicrobial stewardship
Chapter 3: Quality Indicators and Quantity Metrics of Antibiotic Use
Quality Versus Performance Indicators
Quantity Metrics and Quality Indicators of Antibiotic Use: What is the Difference?
Outpatient and Inpatient Antibiotic Use: How to Measure?
International Recommendations
Wide Variations in the Literature
Outpatient Quality Indicators
Section B: AMS Strategies
Chapter 4: Improving Antimicrobial Prescribing: Input from Behavioral Strategies and Quality Improvement Methods
Stewardship Interventions
Effectiveness of Behavioral Stewardship Interventions
The Importance of Understanding the Key Drivers of Current Prescribing Behavior
The Key Drivers of Current Antimicrobial Prescribing Behavior
Use of Theories in Selecting and Developing Behavioral Stewardship Interventions
Use of Systematic Reviews of Behavioral Interventions in Selecting and Developing Behavioral Stewardship Interventions
Chapter 5: Education of Healthcare Professionals on Responsible Antimicrobial Prescribing
Undergraduate Education of Prescribers
What Content Should Be Included for Undergraduates?
How Should Content Be Structured and Delivered in an Undergraduate Program?
Postgraduate Education of Prescribers
Medical Doctors in Training (Internship, Specialization)
Continuing Medical Education and Continuing Professional Development
Types of Educational Activities for Healthcare Professionals
Education of Other Healthcare Professionals in Antimicrobial Stewardship
Competencies in Antimicrobial Stewardship
Chapter 6: Rapid Diagnostics and Biomarkers for Antimicrobial Stewardship
Why Do We Need Rapid Diagnostic Tests?
Novel Technologies to Speed up Microbial Identification
Application of Rapid Diagnostic Tests in Different Clinical Scenarios
Selection and Implementation of Rapid Diagnostic Tests at a Local Level
The Ideal Biomarker for Clinical Use in Infectious Diseases
Implementation of a Biomarker-Based Strategy to Guide Antimicrobial Therapy
Chapter 7: Pharmacokinetic and Pharmacodynamic Tools to Increase Efficacy
PK/PD of Antimicrobials: Efficacy and Resistance
Dose Optimisation Strategies
Alternative Dosing Strategies
Therapeutic Drug Monitoring and Approaches for Dose Modification
Chapter 8: The Use of Computerized Decision Support Systems to Support Antimicrobial Stewardship Programs
Passive Decision Support and Mobile Applications
Back-End Computerized Decision Support and Surveillance Systems
Antimicrobial Restriction/Approval Based Systems
Electronic Prescribing Systems (With or Without CDSS)
Advanced Decision Support
Chapter 9: The Role of Microbiology Laboratory in Promoting Antimicrobial Stewardship
Rapid Diagnostic Tests (RDTs)
Antimicrobial Susceptibility Testing
Communication between AMS team members
Chapter 10: The Role of Pharmacists
Antimicrobial Stewardship Programs
Therapeutic Drug Monitoring and Dose Optimisation
Surveillance of Antimicrobial Consumption and Linking to Resistance
Procurement, Medicines Preparation and Managing Shortages
Education of Healthcare, Staff and Patients
Chapter 11: The Roles of Nurses in Antimicrobial Stewardship
Nurses With Prescribing Rights
Nonprescribing Staff Nurses in Hospitals, in the Outpatient Setting and in Long Term Care Facilities
What Needs to Be Addressed?
Nurses Working Within an AMS Team
Conclusions and Perspectives
Chapter 12: Antifungal Stewardship
Basic Principles of Antifungal Stewardship
Use of Cultures for the Diagnosis of Invasive Candidiasis
Is There a Useful Biomarker or a Molecular Diagnostic Tool for the Diagnosis of Invasive Candidiasis?
What Should Be Done for Detection of Distant Foci?
Is There a "Pre-Emptive" Modality for the Treatment of Invasive Candidiasis?
Are Antifungal Susceptibility Tests Helpful for the Management of Invasive Candidiasis?
How to Choose an Antifungal Drug
C. parapsilosis: Treat With What?
What is the Duration of Therapy?
When to Switch to Oral Therapy?
What About Intravascular Catheters?
Candida Growth in Respiratory Specimens
Candida Colonization: Does It Matter?
What Are the Differences in the Management of Candidiasis Among Neutropenic and Nonneutropenic Patients?
The Role of "Conventional" Microbiology in the Diagnosis of IA: Microscopy, Stains, and Culture
Is There a Useful Biomarker or a Molecular Diagnostic Tool for the Diagnosis of IA?
The Role of Radiology in the Diagnosis of IA
Antifungal Susceptibility Tests for the Management of IA
Section C: AMS in Specific Clinical Settings
Chapter 13: Optimising Prescribing for Acute Respiratory Tract Infections as an Example for Antimicrobial Stewardship in ...
Antibiotics in Primary Care
Barriers to Rational Use of Antibiotics
Approaches to AMS in Primary Care
Systematic Prescribing Feedback
Governance and the Public
Chapter 14: Antimicrobial Stewardship: What to Tell the Patients and the General Public
Studies of Patient Satisfaction
Knowledge on Antimicrobials and Resistance
Measuring the Impact of Interventions
Chapter 15: Antimicrobial Stewardship in Long-Term Care Facilities
Bacterial Resistance in LTCFs
Antibiotic Prescribing: A Challenge in LTCFs
Difficult Decision-Making Process: High Level of Diagnostic Uncertainty
Healthcare Organization and Culture
Lack of Local Resistance and Antibiotic Use Data
High Prevalence of Bacterial Colonization
Antibiotic Use and End-of-Life Care
Patients' and Families' Expectations
Lack of Awareness of the Bacterial Resistance Problem
Potential Strategies to Improve Antibiotic Use in LTCFs
Limit Antibiotic Prescriptions Without a Clinical Examination
Microbiological Investigations
Reassess Antibiotic Prescriptions Around Day 3
Role of the Microbiology Laboratory
Rapid and Point-of-Care Diagnostic Tests
Innovative Strategies Need to be Tested
Conclusions and Perspectives
Chapter 16: Antimicrobial Stewardship in ICU
Definition of AMS in the ICU, Rationale for Stewardship. Who Does What?
Appropriate Diagnostics in Suspected Bacterial Infections in ICU Patients
Selection of Initial Antibiotic Therapy and Timeliness
Pharmacokinetic-Pharmacodynamics-Optimized Antimicrobial Therapy
PK/PD Optimized Therapy-Putting the Pieces of the Puzzle Together
Step 1. Selecting the PK/PD Target
Step 3. Optimized Maintenance Dose
Antimicrobial Therapy De-escalation
Shortening Antimicrobial Treatment Duration
Implementing a Structured Antibiotic stewardship Program
Measuring Effectiveness of an AMS in ICU: Quality Indicators and Bundle Approach; Quantity Metrics
Decision Support/Use of Modern Technology to Optimize Antibiotic Stewardship Programs in ICU
Chapter 17: Antimicrobial Stewardship in Hematology Patients
Epidemiology of Infecting Bacteria and Their Antimicrobial Susceptibility in Patients with Hematological Malignancies
Early Diagnostic Strategies
Are All Patients With Febrile Neutropenia Equal? Risk Assessment for a Complicated Infection
Prevention of Infection and Prophylaxis
Optimizing Antibiotic Delivery With Pharmacokinetics/Pharmacodynamics (PK/PD) Considerations in Patients With Febrile Neutr ...
Role of Infectious Diseases (ID) Consultation and Cooperation With Microbiology for the Management of Patients With Febrile ...
Empirical Antimicrobial Strategies
Targeted Therapy for Documented Infections
How Long is Long Enough for Empirical and Targeted Antibacterial Therapy in Patients With Febrile Neutropenia?
Chapter 18: AMS in an Era of Multidrug-Resistant Bacteria
18.1. Infections Due to ESBL-Producing Bacteria: How to Promote AMS?
Empirical Therapy for ESBL-E: When and How
Targeted Therapy of ESBL-E
Helping to Avoid the Selection and Spread of ESBL-E
Implementing AMS Activities Related to ESBL-E
Case 1: Empirical Therapy
18.2. An Outbreak of Carbapenem-Resistant or Polymyxin-Resistant Strains: How Can Antimicrobial Stewardship Help?
Prevention of Acquisition and Spread
General Considerations in AMS for ESBL-E and CRGNB
Section D: AMS Experiences Around the World
Chapter 19.1: AMS Initiatives and Policies: The International Picture
Chapter 19.2: Missions and Objectives of EUCIC and ESGAP
Chapter 19.3: Antimicrobial Stewardship in Latin America
Chapter 19.4: Antimicrobial Stewardship in Australia
Chapter 19.5: Antimicrobial Stewardship in Austria
Chapter 19.6: Antimicrobial Stewardship in Belgium
Chapter 19.7: Antimicrobial Stewardship in Bulgaria
Chapter 19.8: Antimicrobial Stewardship in Croatia
Chapter 19.9: Antimicrobial Stewardship in England
Chapter 19.10: Antimicrobial Stewardship in France
Chapter 19.11: Antimicrobial Stewardship in Germany
Key Developments and Programmes Associated With Improvements in Responsible Antibiotic Use
National Action Plan and New Legislations
More Transparency and Better Coverage of Consumption and Resistance Data
Hospital Antibiotic Stewardship (ABS) Practice Guideline
Hospital Antibiotic Stewardship (ABS) Expert Training and Certification
Chapter 19.12: Antimicrobial Stewardship in Greece
Efforts and Challenges in the Greek Context
Chapter 19.13: Antimicrobial Stewardship in India
Chapter 19.14: Antimicrobial Stewardship in Israel
Chapter 19.15: Antimicrobial Stewardship in Italy
The region Emilia Romagna
The region Friuli Venezia Giulia
Chapter 19.16: Antimicrobial Stewardship in Japan
Chapter 19.17: Antibiotic Stewardship in the Netherlands
Chapter 19.18: Antimicrobial Stewardship in Scotland
Chapter 19.19: Antimicrobial Stewardship in Slovenia
Chapter 19.20: Antimicrobial Stewardship in South Africa
Chapter 19.21: Antimicrobial Stewardship in Argentina
Chapter 19.22: Antimicrobial Stewardship in Spain
Chapter 19.23: Antibiotic Stewardship in Sweden
Formation of Strama: The Swedish Strategic Programme Against Antibiotic Resistance
Main Successes of the Strama Work
Chapter 19.24: Antimicrobial Stewardship in Switzerland
Chapter 19.25: Antimicrobial Stewardship in Turkey
Chapter 19.26: Antimicrobial Stewardship in the United States
Section E: Research and Perspectives
Chapter 20: Methodological Challenges in Evaluating Antimicrobial Stewardship Programs: "Through Measuring to Knowledge"
Confounding, Maturation, and Regression to the Mean
Experimental Designs: Randomized Controlled Trials
Experimental Designs: Cluster-Randomized Controlled Trials
Experimental Designs: Cluster-Randomized Controlled Trials with Cross-Over
Experimental Designs: Stepped-Wedged Design
Quasiexperimental Designs
Quasiexperimental Designs: Nonrandomized Controlled Trial
Quasiexperimental Designs: CBA Studies
Quasiexperimental Designs: Interrupted Time Series
Statistical Methods: Experimental Designs
Statistical Methods: Quasiexperimental Designs
References and Further Reading*
Antimicrobial Stewardship
( Volume 2 )
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