Antibiotics are medicines that can treat bacterial infections, but at the same time upset microbial ecology, causing an alteration in the normal bacterial flora of the patient. Antibiotics cannot treat viral infections such as the common cold or the flu. Some organisms are sensitive or resistant to a given antibiotic, whilst others acquire resistance. How? If antibiotics are taken when they are not truly needed or beneficial to the individual, they can stop working. This is referred to as antibiotic resistance.
Antibiotic Resistance
Antibiotics may be:
- Broad Spectrum Antibiotics: active against both gram +ve and gram -ve bacteria
- Narrow Spectrum Antibiotics: active against gram -ve bacteria only
- Bacteriocidal – kill bacteria in a direct way
- Bacteriostatic – slow the reproduction of bacteria
Antibiotic resistance happens when an antibiotic loses its ability to kill or control bacterial growth in an effective way, thus leading to bacterial growth within the presence of therapeutic levels of the antibiotic.
Similarly, bacteria may undergo structural changes in its DNA, with different bacteria exchanging DNA information, leading to further antibiotic resistance.
Antibiotic Pressure in Hospitals
Antibiotic use is concentrated in hospitals, making it easy for resistant bacteria to proliferate in the hospital setting as well as in the patients themselves. Unresponsive therapy for resistant organisms leads to an increase in treatment time, making cross-infections more likely to occur. This causes increased antibiotic-resistant hospital infections.
Nosocomial pathogens include bacteria, viruses and fungal parasites. WHO estimates that approximately 15% of all hospitalised patients suffer from such infections. During hospitalisation, the patient is exposed to pathogens found in the surrounding environment, healthcare staff, and other infected patients. Nosocomial pathogens, which are often resistant to the antibiotics in current use, include:
- Staphylococcus aureus (S. aureus / MRSA)
- Enterococci
- Klebsiella / Enterobacter / Serratia
- Pseudonomas Aeruginosa / Acinetobacter
Carbapenem-Resistant Enterobacteriaceae (CRE)
Carbapenem-Resistant Enterobacteriaceae (CRE) are strains of bacteria which are resistant to carpabenem – an antibiotic class, which is used to treat severe infections. CRE are also resistant to most other commonly used antibiotics, and in some cases, to all available antibiotics.
CRE can spread and share their antibiotic-resistant qualities with healthy bacteria in the body, possibly causing infections in the bladder, blood, or other areas. Unfortunately, when such infections happens, it’s very hard and at times impossible to treat effectively.
Methicillin-Resistant Staphylococcus Aureus (MRSA)
MRSA is a type of bacteria resistant to widely used antibiotics, making infections with MRSA harder to treat than other bacterial infections.
Antimicrobial Resistance (AMR)
Antimicrobial resistance can be reduced through prudent and rational antibiotic use. This can be achieved through programmes aimed at preventing and containing healthcare associated infections and antimicrobial resistant organisms.
Global Action Plan on Antimicrobial Resistance (WHO)
Antibiotics are life-saving. However, they are only effective when working against the organism causing the infection. Antibiotics should be prescribed and used with responsibility, so as not to contribute to the ever-increasing antimicrobial resistance.
Antibiotic resistance causes:
- slower response to therapy
- increased risk of infection
- additional investigations
- unnecessary treatments
- use of broad-spectrum antimicrobials which increase cost and may lead to potential adverse reactions
- increased morbidity and mortality
- increased risk of infection spreading across the hospital and the community
- longer hospital stay
- longer absence from work
Antimicrobial Stewardship (AMS)
Through Antimicrobial Stewardship, we can do our part in ensuring we use antibiotics correctly so that they remain active for future generations.
Question everything…
- Is an antibiotic really necessary to treat the patient?
- If yes, does the choice of antibiotic follow the hospital antibiotic prescribing guidelines?
- Have microbiology samples been taken and sent to the lab and the results reviewed?
- Is the antibiotic of choice being administered through the correct route, for the correct duration, and at the correct dose?
- Is a daily review on antibiotic use being performed so as to see if it can be stepped down from IV to oral or stopped?
The Role of the Nurse in Antimicrobial Stewardship
- nurses make up a big part of the healthcare workforce
- nurses are the ones mostly present around the patients
- nurses are patient advocates
- nurses are involved in patient education, infection prevention and control, monitoring of antibiotic use, and medication prescription and management of the patient
- nurses are a part of the multidisciplinary team that sees to the patient’s needs
- nurses work within multiple levels in local clinical settings
- nurses have a key role in safeguarding the effectiveness of antibiotics fur future generations
Thus…
Nurses NEED to be recognised as influential members of the multidisciplinary team in the fight against antimicrobial resistance whilst assuring antimicrobial stewardship.
Through leadership skills, nurses can support infection prevention and control, antimicrobial stewardship and public health.
Patient Management
- understand the difference between colonisation and infection
- perform hand hygiene before and after touching a patient and surroundings
- ensure environmental cleaning procedures are complete and consistent
- assess patients for risk of acquiring and transmitting an infection
- ensure correct collection of microbiological specimens if clinical need is indicated
- encourage targeted interventions to reduce unnecessary use of antibiotics
- ensure the use of most narrow-spectrum antibiotics are used to treat a patient’s infection
- review and recognise if treatment is not in line with microbiological result
- document findings
- facilitate discharge planning
Medication management
- recognise if patients are able to tolerate oral intake and so could change from IV to oral antimicrobials
- ensure timely administration of antimicrobials at the right rate and follow up on missed doses
- ensure that antimicrobials which perform optimally within a specific therapeutic level are in line with recommendations
- monitor patient to ensure intended therapeutic effect of antimicrobial
- recognise allergies and side effects
- document clearly and accurately the generic name, dose, time, route, reason for administration, review, and stop date, as well as each administration
- dispose of unused antimicrobials correctly
Antibiotic Allergies
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