1. SUPERBUGS: STRUMENTI DI INTERVENTO NELL’ERA POST-ANTIBIOTICA
Nicola Petrosillo
Dipartimento Clinico e di Ricerca in Malattie Infettive
INMI «L. Spallanzani», IRCCS - Roma

2. Emerging Threats in Healthcare2

3. MDR organisms in the healthcare setting: from ESKAPE to ESCAPE
We are currently facing new microbiological, infection control and clinical issues, and the epidemiologic variations observed in the last years highlighted the need of a change from the initial proposed acronym:
“ESKAPE” “ESCAPE”
E. faecium E. faecium
S. aureus S. aureus
K. pneumoniae  C. difficile
A. baumannii A. baumannii
P. aeruginosa P. aeruginosa
Enterobacter species Enterobacteriaceae

4. Euro Surveill 2013; 18:46

6. ECDC/EMA: European Annual Cost Estimates of Five Top MDRB

7. Hospital and Societal Costs of Antimicrobial-Resistant Infections (ARIs)
An economic analysis of the
Chicago Antimicrobial Resistant Project dataset:
188 / 1391 patients (13.5%) with ARI
Medical costs attributable to ARI
$18,588 - $29,069 / patient
Excess LOS
6.4 – 12.7 days
Attributable mortality
6.5%
Societal costs
$ $15.0 million
Roberts RR et al. Clin Infect Dis 2009;49:

9. Less surgery for the risk of AMR
Caesarean sections contribute about 2% to world GDP
Joint replacements add about 0.65%
Organ transplant add about 0.1%
These are just a small number of the areas in modern medicine that risk being undermined if we do not have effective antibiotics in the future
Concerns for international travels less trade affecting mainly developping countries

10. Estimates of Preventable Infections, Deaths, and Costs10

11. Antimicrobial Stewardship Programs
ASPs are designed
to optimize antimicrobial therapy,
1-to improve patients’ outcomes,
2-ensure cost-effective therapy and
3-reduce adverse effects associated with antimicrobial use, including antimicrobial resistance and C difficile occurrence

12. INFECTION CONTROL AND ANTIBIOTIC STEWARDSHIP
Although the responsibilities of antimicrobial stewardship programs and infection control departments are different, collaboration between these groups is essential in
promoting optimal outcomes,
providing cost-effective care,
reducing the development of resistance, and
preventing the spread of infection.

13. Infection control departments must rely on stewardship programs to help minimize excessive antibiotic exposure, which ultimately decreases the level of risk that patients face with regard to acquiring infections due to multidrug-resistant organisms.

14. Antimicrobial stewardship programs rely on good infection-control practices, in a complementary fashion, to minimize the patient-to-patient spread of multidrug resistant bacteria.
Poor infection control practices can lead to increasing number of patients with multidrug-resistant infections, which leads to a downward spiral of increased utilization of broad-spectrum antibiotics and the further development of resistance.

15. Additionally, antimicrobial stewardship programs and infection control practitioners are well positioned to identify and improve patient outcomes linked to a specific disease because they already target patients with specific infections, disease states, or patients receiving certain antimicrobials.

16. Interactions between ASP and IC professionals
Drug-based antimicrobial stewardship
Disease-based antimicrobial stewardship and multidisciplinary bundle
Device-associated Infection Prevention
Barriers to implementation and maintenance of stewardship programs
Making a business case for antimicrobial stewardship
Measuring the impact of the Program

19. From competence to meta-competence Antimicrobial Stewardship (A-Teams)
Thera-py
Antimicrobial Stewardship (A-Teams)
ID-doctor
Intensivist
Pharmacist
Theragnostic-concept
Clin. Microbiol. ABS
Clin. Microbiol - infection prevention
PHS
Moleculair
Medisch Microbioloog
Infection Control
Practitioner
Infection Prevention
Stewardship
Dia-gnostic Stewardship
Dik et al Future Microbiology
Courtesy Prof. A Friedrich