Can you introduce yourself and your role within the drive-AMS project in Lithuania?
I’m an infectious diseases physician and work in the Santaros Klinikos hospital in Vilnius where I’m the Chief of the Infectious Diseases Department. Next to that, I teach at the Vilnius University and am a trainer in the drive-AMS programme. I work in a big hospital with over 30 different departments and centres, so there also is a higher rate of resistant infections. Therefore, a well carried out antimicrobial stewardship (AMS) programme is essential. I also did the ESCMID AMS course 2022-2024 to further my knowledge on this topic.
¿Cómo están implementando la gestión antimicrobiana en sus hospitales?
We started our AMS programme at our Infectious Diseases centre. We held regular meetings with the physicians and went through the treatment of patients who got administered antimicrobials. We looked at various aspects such as IV versus oral treatments, duration, the indications and cultural teachings. We measured the results and gave feedback to improve the appropriate use of antimicrobials, which did get better.
We are expanding AMS outside of our centre to other specialties, we have already worked with abdominal surgeons, for example. We assisted them with making sure that the antimicrobial treatments were correctly indicated in the medical records or in improving an appropriate surgical prophylaxis.
Claro, aquí tienes algunos ejemplos concretos de actividades de AMS: * **Monitoreo de sistemas:** Supervisar la disponibilidad, el rendimiento y la seguridad de servidores, bases de datos, redes y aplicaciones. Esto puede incluir la configuración de alertas para notificar al personal de TI sobre problemas potenciales. * **Gestión de parches y actualizaciones:** Implementar y gestionar parches de seguridad y actualizaciones de software para sistemas operativos, aplicaciones y firmware para proteger contra vulnerabilidades y mejorar la funcionalidad. * **Gestión de copias de seguridad y recuperación ante desastres:** Establecer y mantener soluciones de copia de seguridad para proteger los datos y desarrollar planes de recuperación ante desastres para garantizar la continuidad del negocio en caso de fallos del sistema o incidentes graves. * **Gestión del rendimiento:** Analizar datos de rendimiento para identificar cuellos de botella, optimizar la configuración y garantizar que los sistemas funcionen de manera eficiente para satisfacer las demandas de los usuarios. * **Gestión de la seguridad:** Implementar y mantener medidas de seguridad, como firewalls, sistemas de detección de intrusiones y controles de acceso, para proteger los sistemas y los datos contra acceso no autorizado y amenazas. * **Gestión de la configuración:** Documentar y mantener la configuración de los activos de TI, asegurando la coherencia y la trazabilidad de los cambios en el entorno. * **Gestión de la capacidad:** Planificar y pronosticar las necesidades futuras de recursos (CPU, memoria, almacenamiento, red) para garantizar que los sistemas puedan manejar el crecimiento y las cargas de trabajo esperadas. * **Resolución de problemas y soporte técnico:** Diagnosticar y resolver problemas técnicos que surjan en los sistemas, proporcionando soporte a los usuarios finales. * **Automatización de tareas:** Desarrollar y desplegar scripts o herramientas para automatizar tareas repetitivas de gestión de sistemas, como reinicios de servidores, despliegue de software o limpieza de registros. * **Monitoreo y gestión de la infraestructura en la nube:** Si aplica, supervisar y gestionar los recursos de la nube (AWS, Azure, GCP) para garantizar su rendimiento, seguridad y optimización de costos.
Of course, we have put some restrictions in place but we mainly try to focus on persuading doctors instead of solely restricting them. We provide a lot of feedback and give good examples such as switching to oral treatments.
En tu trabajo diario, ¿cuáles son los principales desafíos o sesgos con los que te enfrentas en lo que respecta a la RAM?
In certain departments there is more resistance, for example, in the intensive care unit, haematology and where immunosuppressed patients are being treated with prolonged courses of antibiotics. There we see a lot of cases of Acinetobacter baumannii and gram-negative bacteria resistance. Consequently, this creates other challenges such as selecting the right antibiotic that will still work and the best infection control measures.
Is there also some resistance from the doctors to adhere to these measures and guidelines when it comes to AMS?
I think it’s important to recognise that doctors have habits and routines. We know that certain practices have been around for a long time, so changing behaviours takes time. We are persistent however, we show them our results and help them understand that investing time to improve AMS is essential. And after a while, we see that their habits adapt and they become part of their new routine.
Can you share some (personal) stories of how AMR affected patients?
I remember a case during COVID, where a patient got operated for a cardiological problem and afterwards developed mediastinitis with resistant bacteria. He unfortunately also got COVID and was transported to our department. He had a large open wound on his sternum which was treated with sponges doused in antimicrobials. He luckily eventually recovered from COVID but he had to remain in the hospital for a year before the several resistant infections finally cleared. That is sometimes the case with such patients, a prolonged hospitalisation is necessary and there are often other complications.
Interested to know more about the Lithuanian drive-AMS network? Read our interview with the country lead Prof. Rolanda Valinteliene aquí.