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Test 9: Antimicrobial stewardship

  1. Antimicrobial resistance is:
    • The ability of pathogens to multiply under difficult circumstances
    • The ability of pathogens to multiply in healthcare environments
    • The ability of pathogens to grow in the presence of a drug that would normally kill them
    • The ability of pathogens to overcome the human host’s immune defences.
  2. Antimicrobial resistance:
    • Results in better outcomes for patients
    • Has decreased costs of treatment for common infections
    • Is not a common problem worldwide
    • Makes available antimicrobials less effective and infections more difficult to treat.
  3. The development of antimicrobial resistance is:
    • An entirely preventable phenomenon
    • An inevitable phenomenon as pathogens evolve and adapt to new environments
    • Unaffected by antimicrobial usage
    • Not a problem as new antimicrobials are being developed constantly.
  4. Antimicrobial resistance in healthcare facilities is spread mainly by:
    • Poor IPC practices (including poor hand hygiene compliance)
    • Use of antibiotics as growth promoters in animal farming
    • Inadequate environmental cleaning
    • Exposure of pathogens to disinfectants.
  5. Patients with antimicrobial resistant infections:
    • Are less likely to die from their infection than patients with drug-sensitive pathogens
    • Are more likely to die from their infection than patients with drug-sensitive pathogens
    • Have shorter duration of hospitalisation than patients with drug-sensitive pathogens
    • Cost less to treat than patients with drug-sensitive pathogens.
  6. Antimicrobial stewardship programmes:
    • Aim to improve patient outcomes
    • Raise awareness of the problem of antimicrobial resistance
    • Encourage rational usage of antimicrobials
    • All of the above.
  7. The most important reason to implement antimicrobial stewardship is:
    • To conserve the effectiveness of antimicrobials for the future
    • To save healthcare facilities money
    • To limit the number of antimicrobials that doctors can prescribe
    • To avoid patients developing side-effects from antimicrobials.
  8. The negative consequences of antibiotic overuse and misuse are called:
    • Consequent damage
    • Collateral damage
    • Concomitant damage
    • Consequential damage.
  9. The ideal antimicrobial stewardship committee should be made up of:
    • Clinicians (doctors and nurse practitioners) and data managers
    • Hospital management, a microbiologist and a senior doctor
    • Pharmacy, the IPC practitioner and a senior doctor
    • A manager, clinician, pharmacist, microbiologist, data manager and IPC practitioner.
  10. Information on antimicrobial usage can be used by the stewardship committee to:
    • Identify high usage drugs and clinical areas that use them most
    • Punish individual ‘high-volume’ prescribers
    • Impose penalties on the clinical areas with highest usage
    • Draw up local guidelines for antimicrobial usage.
  11. Essential resources needed for an antimicrobial stewardship programme include:
    • Significant funding or financial resources from the healthcare facility
    • An infectious diseases physician
    • A pharmacist with training in infectious diseases
    • An enthusiastic and dedicated antimicrobial stewardship programme committee.
  12. Antimicrobial stewardship programmes can save healthcare facilities money by:
    • Saving patients’ lives
    • Reducing length of hospitalisation and avoiding unnecessary drug usage
    • Preventing spread of drug-resistant pathogen
    • Preventing colonisation of staff members with resistant pathogens.
  13. The IPC practitioner contributes to antimicrobial stewardship through:
    • Multiple activities that reduce the spread of resistant pathogens
    • Reporting poor IPC practices to the healthcare facility manager
    • Performing daily ward rounds in the clinical areas
    • Advising clinicians on incorrect prescribing practices.
  14. Empiric antimicrobial therapy:
    • Is given routinely before appropriate microbiological specimens have been taken
    • Consists usually of a single antimicrobial drug that targets the most likely pathogen
    • Usually includes several anti-infective drugs that cover the most likely causative pathogens
    • Is continued even after the definitive cause of the infection is identified.
  15. Targeted antimicrobial therapy:
    • Aims to match the antimicrobial given to the specific pathogen-causing infection
    • Uses broad-spectrum antibiotics to cover all potential pathogens
    • Does not require the collection of appropriate microbiological specimens
    • Usually requires several different antimicrobials to be prescribed.
  16. Selective reporting:
    • Involves microbiologists phoning clinicians to inform them of drug-resistant pathogens
    • Presents clinicians with all possible antimicrobial treatment options for confirmed pathogens
    • Discourages prescribers from using targeted antimicrobial therapy
    • Presents clinicians with only the most narrow-spectrum antimicrobials that the pathogen is sensitive to.
  17. De-escalation of antimicrobial therapy:
    • Means changing the patient’s prescription from a narrow to a broad-spectrum antimicrobial
    • Is potentially harmful, even if the pathogen is sensitive to a narrow-spectrum antimicrobial
    • Ensures effective therapy but reduces harmful effects of broad-spectrum antimicrobials
    • Means that therapy should be stopped or discontinued.
  18. Prolonged courses of antimicrobials:
    • May encourage the development of antimicrobial resistance
    • Do not increase the risk of side-effects for patients
    • Are needed as prophylaxis for patients undergoing surgical procedures
    • Are needed for all patients with serious infections.
  19. An antimicrobial restriction policy:
    • Prevents clinicians from accessing essential antimicrobials
    • Limits access to selected antimicrobials, without prior approval from a senior person
    • Should be implemented identically at all healthcare facilities
    • Does not need clinicians with insight into antimicrobial management to be available.
  20. Antimicrobial prescription guidelines:
    • Should be based on international antimicrobial recommendations
    • Are unhelpful when implementing antimicrobial stewardship
    • Give recommendations on antimicrobial selection, dose and duration based on local data
    • Give recommendations on which brands of antimicrobials to use.