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Health Economics

Bugs, Drugs and Antimicrobial Stewardship

By March 6, 2015 No Comments

A run-down of the recent Antimicrobials 2015 conference by Elaine Lum; PhD Candidate with the Centre of Research Excellence in Reducing Healthcare Associated Infections, and an AusHSI grant recipient

Antimicrobials 2016 in Melbourne (25 – 27 February) will be a brilliant conference, if this year’s is anything to go by.  It was my first time attending the annual scientific meeting of the Australian Society for Antimicrobials (ASA) held recently in Brisbane, where I also presented a poster outlining my research “Making decisions about antibiotic use in the Australian primary healthcare sector”.

As a clinical pharmacist and seasoned conference attendee, I can honestly say the scientific program was outstanding for its breadth and depth of topic coverage, delivered by a stellar cast of national and international researchers in the field of antimicrobial research such as rapid diagnostics, antimicrobial usage, antimicrobial resistance and stewardship.  The program catered to a diverse range of participants – clinical microbiologists, infectious diseases physicians, respiratory and ICU physicians, medical and non-medical microbiologists and scientists, and clinical pharmacists.

These are the top 5 things I valued and/or learned at Antimicrobials 2015.

1. There are stewardship myths … and there is evidence to debunk each one (A/Prof Sara Cosgrove)

Five Stewardship Myths

  • We don’t need to require stewardship because hospitals will do it on their own
  • Stewardship can’t be done by prescribers
  • Rapid diagnostics will make stewardship unnecessary
  • We need more multicentre studies to show that stewardship works
  • Stewardship can’t be done in certain populations.

2.  Rapid diagnostics alone will not make a difference to patient care and patient outcomes.  You need to also implement an effective antimicrobial stewardship program that helps prescribers act on test results in a timely and appropriate way (A/Prof Sara Cosgrove).

3.  Think outside the box about interventions – what if we could reduce inappropriate use of antibiotics for asymptomatic bacteriuria by not reporting on urine cultures? (A/Prof Sara Cosgrove)

4.  Globally, we need to take a One Health approach when tackling antimicrobial resistance, to reduce inappropriate use of antimicrobials in both human and animal health.  High use of antimicrobials in the agriculture sector creates reservoirs of resistant micro-organisms in animals for food production.  These resistant micro-organisms with potential to cause infections, have found their way into people through the food chain.  Concerted action is needed now to mitigate the rise of antimicrobial resistance in food products globally (Prof Jan Kluytmans).

5.  Harnessing the power of technology for greater good.  I’ve highlighted 3 examples – global, local and glocal (reflecting both global and local considerations).

  • Technology for de-centralised rapid testing of various infections including multidrug resistant tuberculosis – vital for developing countries where poor roads and transport can mean higher mortality rates due to significant delays in treatment of patients.  Rapid diagnostics allow treatment to be started within hours – often while the patient is still in the clinic.  A new test for Ebola will reduce turnaround time for results from days to just 90 minutes.  These de-centralised diagnostic units are enabled for live data streaming for cloud based monitoring of emerging infections (Dr David Persing).
  • An app for antimicrobial stewardship linked to an electronic medication management system at St Vincent’s Hospital, Sydney.  Bonus spin-off:   a highly efficient way to gather data for the annual National Antimicrobial Prescribing Survey.   I was sold on a key feature of the app – customizable views by ward or your role for reviews and/or approvals e.g. ID physician, Registrar, JMO, pharmacist (Jessica Del Gigante).
  • An interactive web-based simulation for meropenem infusion at Princess Alexandra Hospital, Brisbane.  Available here for free.  Simulations for other medicines – an exciting possibility (David McDougall).

As the conference drew to an end, it was apparent that excellent work on antimicrobial stewardship was being done in the acute care sector, but little research was presented in the area of primary healthcare.  By investigating and establishing what factors are dominant in influencing decisions to use antibiotics in the Australian primary healthcare sector, I hope to contribute towards shaping what antimicrobial stewardship means in this setting.

Acknowledgement:  Participation at the Antimicrobials 2015 conference was made possible by a grant from the Queensland Infectious Diseases Pharmacists Interest Group (QIDPIG).