1. Bugs vs Drugs: Antibiotic Resistance in the Community Charles Welborn, MD, MS, MPH&TM, FAAP, FACEP Division of Emergency Medicine Sidra Medical and Research Center The 2nd Al Jahra International Pediatric Conference May 5, 2017

2. DISCLOSURE I do not have any relevant financial relationship with commercial interest to disclose.

3. Learning Objectives Describe the scope of antimicrobial resistance
Illustrate the need for tailored and focused antimicrobial therapy

4. Antimicrobial stewardship is any system to optimize antimicrobial use

5. Background
In the United States in 2013, approximately 2 million patients affected
23,000 deaths attributed to antimicrobial resistance
250,000 hospitalizations for Clostridium difficile infections
$20 BILLION in increased healthcare costs

6. Background Between 2000 and 2010, antimicrobial use increased 36%
Majority of this increase occurred in rapidly developing countries
MDR, MRSA, and ESBL has moved to the community
142,000 ED visits in the US secondary to antibiotic adverse events.

7. Background
Up to 50% of antibiotics prescribed in the emergency department are unnecessary

8. Antimicrobial Resistance in Kuwait
carbapenem-resistant bacteria, which kills up to half of infected patients - has increased up to 90 percent over the past two decades
Although non-prescription sales of antibiotics are illegal in the GCC states, 68 percent of pharmacies in Abu Dhabi, 78 percent in Riyadh and 87 out of 88 pharmacies included in a study in Saudi Arabia had sold antibiotics to patients unnecessarily and/or without a prescription
75 percent of patients who received antibiotic treatment in the intensive care unit of a Qatar hospital in 2004 did not have a microbiologically-proven infection

9. Antimicrobial Resistance in Kuwait
Average resistance level for all surveyed bacteria was about 27% from 1999 to higher than the 17% for the U.S. and about the same as the 28% China.

10. Aspects of Antimicrobial Stewardship
#1 – Multidisciplinary Quality Improvement

11. Aspects of Antimicrobial Stewardship
#2 – Review local antimicrobial resistance patterns

12. Aspects of Antimicrobial Stewardship
#3 – Antimicrobial order sets

13. Aspects of Antimicrobial Stewardship
#4 – Review all cultures and adjust antibiotic coverage as needed

14. Aspects of Antimicrobial Stewardship
#5 – Antimicrobial Champion

15. Aspects of Antimicrobial Stewardship
#6a – Consider cultures when instituting antimicrobial therapy

16. Aspects of Antimicrobial Stewardship
#6b – Reserve broad spectrum antimicrobials (including antifungal and/or antiviral agents) for patients with septic shock

17. Aspects of Antimicrobial Stewardship
#6c – Avoid antibiotics for uncomplicated skin abscesses

18. Aspects of Antimicrobial Stewardship
#6d – Administer antibiotics for pharyngitis/tonsillitis only for positive rapid strep testing or culture positive strep

19. Aspects of Antimicrobial Stewardship
#6e – No antibiotics for URIs
“Bronchitis”
“Sinusitis”
“Possible ear infection”
Use POCT

20. Aspects of Antimicrobial Stewardship
#6f - Use the Electronic Medical Record to review past antibiotic therapy and culture results

21. Summary
Antimicrobial stewardship is a crucial element in the management of increasing antimicrobial resistance
Antimicrobial stewardship adoption is difficult in the face of multiple obstacles
Multidisciplinary involvement in stewardship programs offers support from related professional disciplines