Quiz 9: Antimicrobial stewardship

Please choose the one, most correct answer to each question or statement.

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.