Dec Decisi ision on Makin Making g for P or PAP f AP for P or - - PowerPoint PPT Presentation
Dec Decisi ision on Makin Making g for P or PAP f AP for P or Pacemak acemaker er Im Implan plantation tation A Model Of Success Key Elements Antibiotic policy versus Antibiotic Stewardship Elements of a Successful
Antibiotic policy versus Antibiotic Stewardship Elements of a Successful Antimicrobial Stewardship
Standardized decolonization treatment consisted of :
mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with Betadine /chlorhexidine soap for 5 days.
1.
Screening For MRS (MRSA / MRCONS)
Nasal –Auxiliary – Ear – Perinea swabs
If candidate is + Ve positive MRS 2.
If candidate is + Ve positive for MRS
Decolonization Procedure
Repeat screening for MRS (MRSA/ MRCoNS )Colonized 3.
Decide on PAP (pre-operative antibiotic prophylaxis) based on culture results.
Duration: 5days
Skin Decolonization:
Wash
Chlorhexidine or Beta dine " body wash " : Once preferably twice daily changing all clothes Special attention to all hairy body surfaces Auxiliary– Perineum
Mupirax cream Auxiliary– Perineum
Nasal Decolonization:
Oral Decolonization: Mouth rinse Chlorhexidine oral rinse 5x per day
Colonization State Body weight <80 kg Body weight 80-160 kg
Persistently colonized Teicoplanin 400 mg Or Vancomycin 1g Teicoplanin 800 mg Or Vancomycin 2g
Decolonized Cefazolin 1g Cefazolin 2g
Total MRS Auxiliary& Nasal carriage among Candidates for Pace maker implantation Before & after implementation of decolonization regimen N umber of patients 128 Concomitant Auxiliary & Nasal carriage Nasal carriage Auxiliary carriage
er impleme lementation ntation of
decolo loniza nization tion re regimen gimen
10 20 30 40 50 60
Nasal Axillary Concomitant Axillary & Nasal carriage
Before After
MR MRS ca carri rriage age among
candi dida dates es for
Pace ce maker er impla plantation ntation Bef efore
er impleme lementa ntation tion of
decolo lonization ization re regimen gimen
+ve Nasal +ve Auxiliary
+ ve Auxiliary + ve Nasal
28 (21.87%) 29 (22.66%) 28 (21.87%) 44 (34.37%) Before (64.84%) 83 ( 9.37% ) 12 ( 14.84% ) 19 ( 3.91% ) 5 After
Total # of Candidates for Pace maker implantation surgery included 128
er impleme lementation ntation of
dec decol
ization re regimen gimen in per erce cent nt
10 20 30 40 50 60 70
A-/N- A-/N+ A+/N- A+/N+ 21.87 22.66 21.87 34.37
64.84 9.37 14.84 3.91
Before After
MR MRSA A & MR MRCoNS
carri rriage ge a among
Candid didates es for
Pace ce maker er implantation lantation Bef efore
er impleme lementation ntation of
CoNS +ve MRSA +ve
86 (67.19%) 23 (17.97%) Before 36 (28.13 %) 3 (2.34%) After
Pace ce maker er impla plantation ntation Bef efore
after er implementation plementation of
dec decol
ization re regimen gimen
10 20 30 40 50 60 70
2.34 28.13
Before After
MRSA+ve MRCoNS+ve MRSA +ve MRCoNS-ve MRSA - ve MRCoNS + ve MRSA - ve MRCoNS -ve
Primary culture results 6 (4.69%) 6 (4.69%) 52 (40.63%) 18 (14.06 % ) After Decoloniz ation
(2.34%) 25 ( 30.5%) 54 (65.8%)
Total # of Candidates for Pace maker implantation surgery included 128
Candid didates es for
Pace ce maker er impla plantation ntation surger urgery y Bef efore
d after er implementation plementation of
Dec ecolon
ization
10 20 30 40 50 60 70
MRSA+/MRCONS+ MRSA+/MRCONS- MRSA-/MRCONS+ MRSA-/MRCONS-
4.69 4.69 40.6 14.1 2.34 30.5 65.8
Before After
Cumulative MRS –Ve Candidates for Pace maker implantation
100 (78.13% )out of 128 patients To 45 (35.16%) patients
The joint effort of IP&C UNIT, Microbiology Lab Antimicrobial Stewardship & The CardioPhysiology Unit set an example of a successful Antibiotic Stewardship Program to limit the abuse of Vancomycin/ Teicoplanin in
For advising & supporting the decolonization /Safe Implant