1 of 55

Cracking EGGS with a HAMMER

Steven Lim

ID Physician

Hospital Raja Permaisuri Bainun

2 of 55

  • Gets the job done
  • Wrong tool for the job
  • Looks overkill
  • Leaves a mess

Cracking eggs with a hammer�

3 of 55

Meropenem

Ceftriaxone

Ciprofloxacin

etc…etc…

Highly susceptible bacteria

Antimicrobial Resistance (AMR)

  • Gets the job done
  • Wrong tool for the job
  • Looks overkill
  • Leaves a mess

Using broad spectrum antibiotics against highly susceptible bacteria�

4 of 55

Case Vignette

47 yo gentleman

  • DM on insulin
  • Gastritis
  • ADL independent

Alleged MVA, sustained:

  • right superior inferior pubic rami fracture
  • right iliac bone fracture
  • acetabular anterior column fracture
  • left 5-7th rib fracture

Urine sample from CBD grew E. coli sensitive to ampicillin

  • Asymptomatic
  • Given ceftriaxone in ward, discharged with oral cefuroxime

5 of 55

Should we treat asymptomatic bacteriuria?

A retrospective study of > 2,700 patients with asymptomatic bacteriuria at 46 hospitals showed that antimicrobial treatment does not improve outcomes and is associated with longer hospitalization

Petty LA, Vaughn VM, Flanders SA, Malani AN, Conlon A, Kaye KS, Thyagarajan R, Osterholzer D, Nielsen D, Eschenauer GA, Bloemers S, McLaughlin E, Gandhi TN. Risk Factors and Outcomes Associated With Treatment of Asymptomatic Bacteriuria in Hospitalized Patients. JAMA Intern Med. 2019 Nov 1;179(11):1519-1527. doi: 10.1001/jamainternmed.2019.2871. PMID: 31449295; PMCID: PMC6714039.

Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic bacteriuria in adults. Am Fam Physician. 2006;74(6):985-990.

“Patients with chronic indwelling Foley catheters are uniformly bacteriuric, but treatment is warranted only if the patient is symptomatic.”

6 of 55

3 things are certain in life: death, taxes and ……

There is always a trade-off when prescribing antibiotics

7 of 55

Readmitted to hospital after 1 month

  • Complained of abdominal pain and distention

  • Developed respiratory distress with severe metabolic acidosis and AKI
    • Intubated in ED
    • Septic looking
    • Started piperacillin-tazobactam

  • US showed a huge right retroperitoneal hematoma.

  • CT scan showed multiple intramuscular collections.

CECT abdomen/pelvis

Revised report: No pneumoperitoneum

8 of 55

Complicated MRSA sepsis

  • Infected retroperitoneal hematoma & multiple intramuscular abscesses

  • Started Vancomycin for MRSA bacteremia

  • Pigtail drainage of retroperitoneal hematoma

  • Persistent AKI requiring intermittent HD

  • High ventilator setting and inotropic support

Blood culture upon admission

9 of 55

ESBL sepsis

  • Initially on piperacillin-tazobactam

  • Switched to Meropenem in view of ESBL bacteremia

  • Condition worsening despite on Meropenem

Blood cultures at ≈ 2nd week

10 of 55

CRE sepsis

  • CXR worsening - VAP

  • Blood and tracheal aspirate grew CRE

  • Switched to polymyxin

  • Worsening AKI

  • Repeated CT scan showed cavitating pneumonia and persistent intramuscular collections

Not available

Blood cultures at ≈ 3rd week

11 of 55

Invasive candidiasis

  • Blood culture grew candida tropicalis
    • Started micafungin

  • Prognosis remained guarded

  • Triple inotropic support

  • Family agreed for withdrawal

  • Length of stay: 7/10/2023 – 5/11/2023 (passed away)

Blood cultures at ≈ 4th week

12 of 55

Casereflections

  • Multiple MDRO Bacteremia: A Clinical Challenge
    • Methicillin-resistant Staphylococcus aureus (MRSA)
    • Klebsiella pneumoniae (ESBL-producing)
    • Klebsiella pneumoniae (Carbapenem-resistant, CRE)
    • Candida tropicalis

  • Key Challenges:
    • Difficult to treat: Limited therapeutic options, ↑LOS & $$$
    • High toxicity risk: Antibiotics such as vancomycin and polymyxins
    • Poor efficacy: CRE-associated mortality remains ~40% even with colistin
    • Novel antibiotics are costly and not easily accessible in LMIC setting

  • “Double whammy”
    • Recurrent MDRO sepsis in a critically ill patient

  • Could the MDRO infections have been prevented?
    • AMS, IPC

13 of 55

COLLATERAL DAMAGE

14 of 55

Increased empirical polymyxin

High CRE / Acinetobacter MRO rates

Increased empirical carbapenem usage

High ESBL rates

Increased empirical 3rd gen cephalosporins usage

Resistance driving resistance

Is polymyxin a saviour drug?

15 of 55

Polymyxin is NOT a savior drug!!!

CLSI has taken the step to eliminate the “susceptible” interpretive category for the polymyxins

Clinical and PK/PD data demonstrate colistin and polymyxin B have limited clinical efficacy, even if an intermediate result is obtained. Alternative agents are strongly preferred. Colistin and polymyxin B should be used in combination with one or more active antimicrobial agents. Consultation with an infectious diseases specialist is recommended.

16 of 55

Novel antibiotics are:

  • costly
  • may not be useful in our setting.

Novel antibiotics

17 of 55

Tumbarello M, Trecarichi EM, Corona A, et al. Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae. Clin Infect Dis. 2019;68(3):355-364. doi:10.1093/cid/ciy492

Multivariate analysis of the 208 cases of KPC-Kp bacteremia identified septic shock, neutropenia, Charlson comorbidity index ≥3, and recent mechanical ventilation as independent predictors of mortality, whereas receipt of CAZ-AVI was the sole independent predictor of survival.

CAZ-AVI appears to be a promising drug for treatment of severe KPC-Kp infections, especially those involving bacteremia.

18 of 55

United States: Approved by the FDA in February 2015.​

European Union: Approved by the European Medicines Agency (EMA) in June 2016. ​

United Kingdom, Sweden, France, Germany, Italy, Norway, Spain, Greece, Romania, Croatia, Denmark: Approved and launched between 2016 and 2020.

Ceftazidime-avibactam

The approval & accessibility of novel antibiotics in Malaysia often lag behind….

19 of 55

Not all CREs are the same.

KPC – America, Europe

NDM – India, SEA

20 of 55

We are at a clear disadvantage in the MDRO endgame!

Novel antibiotics like ceftazidime-avibactam

are promising against KPC,

but NOT against NDM.

>50% of our CRE in HRPB will not respond to ceftazidime-avibactam!

21 of 55

What can we do with NDM-producing CRE?

22 of 55

The use of CAZ-AVI + ATM was associated with lower 30-day mortality (HR, 0.37 [95% CI, .13–.74]; P = .01), lower clinical failure at day 14 (HR, 0.30 [95% CI, .14–.65]; P = .002), and shorter length of stay (HR, 0.49 [95% CI, .30–.82]; P = .007).

CAZ-AVI + ATM

Estimated cost: RM 12k + 3k for 2-week course

23 of 55

Cefiderocol had similar clinical and microbiological efficacy to best available therapy for infections caused by carbapenem-resistant Gram-negative bacteria.

Numerically more deaths occurred in the cefiderocol group, primarily in the patient subset with Acinetobacter spp infections.

Cefiderocol

Trojan horse antibiotics

Not available in Malaysia

24 of 55

AMR trend in Malaysia

Major AMR burden

25 of 55

In 2019 alone, 1.27 million people worldwide died from drug-resistant infections—a figure surpassing deaths from HIV/AIDS and malaria combined. 

A cross-sectional study conducted in private primary care clinics in Malaysia found that only 42.9% of antibiotic prescriptions for acute pharyngitis were appropriate, while over 58.5% of prescriptions were deemed excessive.

A study examining URTI patients in an Emergency Department revealed that 29% of cases received inappropriate antibiotic prescriptions.

26 of 55

These are just the DIRECT impact of AMR

27 of 55

The End of Antibiotics

The End of MODERN MEDICINE

28 of 55

29 of 55

“It has been recognized for several decades that up to 50% of antimicrobial use is INAPPROPRIATE.

Given when not needed

Wrong antibiotic given

Broad spectrum to treat susceptible bacteria

Continued when no longer necessary

Given at wrong dose

IDSA/SHEA Guidelines for Antimicrobial Stewardship Programs

http://www.journals.uchicago.edu/doi/pdf/10.1086/510393

30 of 55

Antimicrobial Stewardship

(AMS)

31 of 55

HIT HARD UP FRONT

Timely appropriate antimicrobial therapy for severe infection to prevent mortality and morbidity

COLLATERAL DAMAGE

Avoid unnecessary broad spectrum antimicrobial use to prevent resistance and adverse effects

Empirical Antimicrobial Therapy

32 of 55

33 of 55

Narrow.

Short.

Oral.

Perak Hospitals

Smart Antibiotics Mantra

Use narrow-spectrum antibiotics

Keep antibiotic duration short

Switch to oral antibiotics early

34 of 55

Narrow.

Use narrow-spectrum antibiotics

Target ≥ 60%

Antibiotic PPS in HRPB 2022-2024

Unpublished data from Cheah MF

35 of 55

Choose the narrowest spectrum antibiotics

36 of 55

Follow local antimicrobial guidelines

  • Evidence based.
  • Local antibiogram.
  • Consensus between local experts.
  • Can be applied to most cases in daily practice.
  • Serve as a GUIDE

https://sites.google.com/moh.gov.my/nag

37 of 55

Short.

Keep antibiotic duration short

Shorter is better….

38 of 55

Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection [published correction appears in N Engl J Med. 2018 Feb 15;378(7):686. doi: 10.1056/NEJMx180006.]. N Engl J Med. 2015;372(21):1996-2005. doi:10.1056/NEJMoa1411162

39 of 55

Short.

Keep antibiotic duration short

40 of 55

Oral.

Switch to oral antibiotics early

41 of 55

ORAL is the new IV

POET

OVIVA

SABATO

42 of 55

If the Gut works, consider oral

43 of 55

Caveats to Short Duration / Early IV-to-Oral Switch

  • Complicated infections WITHOUT adequate source control

  • Organisms known to have high risk of metastatic infections and mortality:
    • Staphylococcus aureus bacteremia (uncomplicated vs complicated)
    • Burkholderia pseudomallei (Melioidosis)

  • Infections involving prosthesis and biofilm formation

  • Sites with poor antibiotic penetration
    • CNS
    • Prostate
    • Bones

“Consult ID for choice and duration of antibiotics…..”

44 of 55

Antimicrobial Stewardship (AMS)

In the YEAR 2023

134 patients were reviewed by AMS team

AMS recommendations were given to primary teams:

  • 84 to DE-ESCALATE antibiotics
  • 40 to STOP antibiotics

79.9% AMS recommendations were ACCEPTED by primary teams

AMS Recommendation

Survived

Died

ACCEPTED

79.4%

20.6%

REJECTED

77.8%

22.2%

AMS can achieve reduction in unnecessary antibiotic consumption without harm to patients.

Appropriate usage of antibiotics will reduce the risk of antimicrobial resistance (AMR).

AMS ward rounds are done regularly to optimize antimicrobial use among patients.

“Would accepting AMS recommendation cause harm to my patient?”

AMS is

SAFE, EFFECTIVE, and IMPORTANT !

Data collected and analysed by MF Cheah, AMS Pharmacist, HRPB

Between patients with AMS recommendation accepted or rejected, there is no significant difference in mortality outcome within 30 days (p=.797)

Please consult the AMS team if your patient is still receiving empiric carbapenem, vancomycin or quinolones for more than 72 hours.

45 of 55

Diagnostic Stewardship

46 of 55

Diagnostic stewardship

47 of 55

Diagnostic stewardship

48 of 55

68 yo man

Underlying DM and HTN

Presented with reduced consciousness

A/w poor oral intake

No fever

No SOB

No abdominal pain

BP: 120/80, PR: 80

Urine FEME: Leukocyte 2+, Nitrite +

Impression: Urosepsis

Plan

Start IV Unasyn 3gm tds

Admit medical

Hyponatremia due to thiazide

  • Consciousness improved after Na correction

“Diagnosis begins with the patient, not the lab.”

49 of 55

Take appropriate cultures ONLY from possible source of infections

  • Blood (periphery/central lines)
  • Sputum (pneumonia)
  • Urine (presence of UTI sx)
  • CSF (CNS infections)
  • Deep tissue (wound debridement)

Swab culture?

Diagnostic stewardship

50 of 55

Infection Prevention and Control (IPC)

51 of 55

Infection Prevention & Control

IPC is essential to fight the development and spread of AMR.

Every infection prevented reduces the need for antimicrobials.

52 of 55

Infection Prevention & Control

Every lines and catheters increase RISK for hospital acquired infections!

DO NOT insert

if it’s not indicated.

REMOVE it

as soon as it’s not needed.

53 of 55

Infection Prevention & Control

Keep every equipment in ward clean.

All solution for patient and connection to patient’s IV access must be kept sterile.

Scrub the hub

54 of 55

  • AMR affects everybody with high mortality and morbidity.

  • Lower middle income countries are affected the most!

  • AMS, diagnostic stewardship, IPC must be adopted in every hospitals.

In a nutshell….

55 of 55