Phys Clinical Cases · infectious
Antimicrobial Stewardship and Resistance — DCE Clinical Case
DCE long-case/short-case station for antimicrobial stewardship and antimicrobial resistance.
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Antimicrobial Stewardship and Resistance — Clinical Case
DCE Long Case
Patient brief
Patient: A hospitalised adult with suspected infection and multiple antibiotic exposures. [1]
Presenting complaint: Fever and focal infective symptoms after recent broad-spectrum therapy. [1]
Past history: Multimorbidity including prior hospitalisations and possible resistant organism risk factors. [2]
Medications: Current and recent antimicrobials, allergies, and interacting drugs. [1]
Examination: Source-focused findings and severity markers. [1]
Investigations: Cultures, inflammatory markers, imaging as indicated, and susceptibility data when available. [2]
Tasks
- Present a stewardship-focused problem list. [1]
- Choose empiric then targeted therapy with de-escalation criteria. [1]
- Define IV-to-oral switch, duration, and resistance-prevention actions. [2]
Model discussion points
- Right drug, dose, route, duration. [1]
- Cultures before antibiotics when safe. [2]
- De-escalation and stop dates. [1]
- Infection prevention and allergy verification. [2]
Short case
Counsel a colleague or patient on why broad-spectrum therapy will be narrowed once microbiology returns. [1]
References
- [1]Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Clin Infect Dis, 2016.PMID 27080992
- [2]McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) Clin Infect Dis, 2018.PMID 29462280
- [3]Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections Cochrane Database Syst Rev, 2017.PMID 29025194
- [4]Wilcox MH, Gerding DN, Poxton IR, et al. Application of Residual Dipolar Couplings and Selective Quantitative NOE to Establish the Structures of Tetranortriterpenoids from Xylocarpus rumphii J Nat Prod, 2017.PMID 28121439
- [5]van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile N Engl J Med, 2013.PMID 23323867
- [6]Louie TJ, Miller MA, Mullane KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection N Engl J Med, 2011.PMID 21288078