Technical Diploma in Antimicrobial Resistance

It is important to recognize that laboratory work and clinical experience must be closely integrated; thus, laboratory-associated clinical duties are an essential component of the training program.

This course aims to provide candidates with a theoretical foundation as well as the practical, technical, clinical, and managerial skills required for health care professionals to detect and manage antimicrobial resistance.

Learning Outcomes

By the end of this module, the participant will be able to:

1. Describe the basic classification/nomenclature system(s) of microorganisms
2. List and compare common methods for isolation, identification and antimicrobial susceptibility testing of microorganisms
3. State the basic mechanisms of antimicrobial resistance
4. List those pathogenic microorganisms that currently present major treatment challenges due to antimicrobial resistance
5. Describe strategies to identify problematic pathogens in a given institution and propose actions to address those challenges to patient care
6. List guidelines for assembly of institutional antibiograms and describe potential pitfalls in interpretation of these reports
7. Describe and list procedures utilizing antibiogram information to identify and track resistance problems, make appropriate antimicrobial formulary decisions, and to prepare optimal clinical pathways at a given institution

Module Outline

1. Pathogenic Microorganisms
2. Identification of Microorganism
3. Antimicrobial Mode of Action
4. Pathogen Isolation and Antimicrobial Sensitivity
5. VITEK and PCR Tests
6. Antimicrobial and Susceptibility Tests
7. Disc Diffusion Method

Antimicrobial resistance is driven by the overuse of antimicrobials and inappropriate prescribing. The increase in resistance is making antimicrobial agents less effective and contributing to infections that are hard to treat. Antimicrobial stewardship initiatives aim to improve the prescribing of all agents, whether they target bacterial, viral, fungal, mycobacterium, or protozoal infections. Educating the public and healthcare professionals in the prudent use of antimicrobials as part of an antimicrobial stewardship program is of paramount importance to preserve these crucial treatments and to help control resistance. Therefore imperative that the candidate be equipped with knowledge and skills on Antimicrobial stewardship.

Learning Outcomes

By the end of this module, the participant will be able to:

1. Demonstrate understanding of the Essential Medicines List (EML) concept, how EML is developed, explaining its role in promoting rational use of medicines, including antimicrobials.
2. Explain the importance of Standard Treatment Guidelines and demonstrate the method of developing them, explaining their role in promoting rational use of medicines, including antimicrobials.
3. Demonstrate understanding of the Pharmacy & Therapeutics Committees (PTCs) at hospitals and explain their vital role in the rational use of antimicrobials.
4. Explain the concept of Hospital formularies and the selection criteria for inclusion of medicines in the hospital formulary depending on different types of health facilities.
5. Illustrate the importance of using international nonproprietary names (INN) or generic names in the EML, STG, and hospital formulary

Module Outline

1. Basics of Antimicrobial Drugs 
2. Mechanisms of Antimicrobial Drugs
3. Spectrum of Antimicrobial Activity
4. Pharmacodynamics of Antimicrobial
5. Introduction to Antimicrobial Stewardship
6. Introduction to Antibiograms
7. Rational Use of Antimicrobial Agents
8. Guidelines to Effective Antimicrobial Treatment

AMR surveillance is the cornerstone for assessing the burden of AMR and for providing the necessary information for action in support of local, national, and global strategies. One of the five strategic objectives of the global antimicrobial resistance action plan that has been adopted by the sixty-eight World Health Assembly is to strengthen the evidence base through enhanced global surveillance and research.

The goal of this module is to equip the candidate with knowledge and skills that enable them to collect, analyze, and share the data on AMR at a global level, to inform decision-making, drive local, national, and regional action, and provide the evidence base for action and advocacy.

Learning Outcomes

By the end of this module, the participant will be able to:

1. Work with antimicrobial and diagnostic stewardship multidisciplinary teams
2. Practice the international standard for laboratory practice
3. Conduct monitoring, evaluation, and development of AMR Surveillance
4. Design AMR surveillance system

Module Outline

1. International Standards for Laboratory Practice
2. Bio-Safety in Laboratory
3. Hazardous Pathogens
4. Standard Precautions in Laboratory
5. Introduction to Antimicrobial Surveillance
6. Sterilization and Disinfection
7. Technical Components of AMR Surveillance
8. Threats of Antibiotic-Resistant Bacteria Outbreak
9. Role of the Lab in Antimicrobial Surveillance
10. Antimicrobial Consumption Monitoring

This module addresses issues of antimicrobial resistance and related genes through an interdisciplinary "One Health" approach, integrating human, animal, and environmental health. It examines the global use and misuse of antimicrobials and their profound impact on the health of humans, animals, and the environment. The goal of this module is to equip candidates with the knowledge, skills, and abilities essential for implementing and promoting Antimicrobial Stewardship.

Learning Outcomes

By the end of this module, the participant will be able to:

1. Compare and analyze diverse viewpoints on controversial issues related to sources of ARGs/ARBs in relationship to humans, animals, and the environment (i.e. One Health)
2. List and compare methods for prospectively measuring antimicrobial use in an organized healthcare setting
3. Prepare and defend a proposal that cost-justifies the funding of a stewardship program
4. Document stewardship interventions and assess their effects
5. Provide in-service training on a stewardship program to other healthcare providers

Module Outline

1. Emergence of Antimicrobial Resistance in Bacteria
2. Relevance of Animal Production in the Emergence of Antimicrobial Resistance
3. Mechanism of Spread of AMR
4. Integrating Rapid Diagnostics into Antimicrobial Stewardship
5. Clinical Decision Support Software Session
6. Designing Stewardship Interventions
7. One Health Approach in Developing NAP-AMR
8. Approach to Multisectoral Systems
9. Core Components of NAP-AMR
10. Antibiotics Policy and Guideline
11. Evidence-Based Good Prescription and Dispension
12. Chain of Infection
13. Best Hygiene Practices
14. Epidemiology of Health Care Acquired Infections
15. Management of Infection Prevention and Control Programs
16. AMR Awareness and Educational Campaign

Resistance to tuberculosis (TB) drugs is a formidable obstacle to effective TB care and prevention globally. Multidrug-resistant TB (MDR-TB) is multifactorial and fueled by improper treatment of patients, poor management of the supply and quality of drugs, and airborne transmission of bacteria in public places. Case management becomes difficult and the challenge is compounded by catastrophic economic and social costs that patients incur while seeking help and spending on treatments.

Learning Outcomes

By the end of this module, the participant will be able to:

1. Apply an interdisciplinary epidemiology approach to study TB, HIV, and malaria drug-resistant
2. Identify factors that influence HIV, TB, and malaria drug resistance
3. Apply strategies for minimizing the development of drug resistance
4. Document stewardship interventions and assess their effects
5. Apply strategies for responding to the detection of moderate to high levels of drug-resistant HIV, TB, and malaria

Module Outline

1. HIV Drug Resistance
2. The HIVDR Laboratory Network
3. Laboratory Diagnosis of HIVDR
4. Control of HIVDR
5. Epidemiology of TBDR
6. Lab Network for Management of TBMDR
7. Rapid Diagnosis of TBDR
8. Xpert MTB/RIF
9. Multidrug-Resistant Tuberculosis (MDR-TB) Control Strategies
10. Challenges to Programmatic Management of Drug-Resistant TB
11. Malaria Drug Resistance
12. Therapeutic Efficacy Studies

This module addresses issues of antimicrobial resistance and genes through an interdisciplinary ''One Health'' approach that integrates human, animal, and environmental health. It explores how global use and abuse of antimicrobials have profound consequences on the health of humans, animals, and the environment. The goal of this module is to provide the candidates with knowledge, skills, and abilities that are critical to implement and promote Antimicrobial Stewardship.

Learning Outcomes

By the end of this module, the participant will be able to:

1. Apply advances in antimicrobial stewardship
2. Apply advances in antimicrobial therapeutics, including new agents, new vaccines, and pharmacodynamics principles to patient care at the patient and system levels
3. Apply epidemiologic and infection control and susceptibility surveillance methods, including the use of electronic data capture software.
4. Propose methods for assessing quality improvement through local, national, and international benchmarking techniques

Module Outline

1. Advanced Pharmacokinetics/Pharmodynamics
2. Indicators to Measure Antimicrobial Prescription
3. Global Antimicrobial Resistance Surveillance System
4. AMR Data Collection and Reporting
5. ASP Costs and Benefits
6. Financial Metrics of ASP
7. Benchmarking ASPs