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Are we running out of antibiotics? - Slideset by Professor Esposito

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How does antibiotic resistance happen?
This work, edited by the professor Susanna Esposito, tries to answer this question underlining the importance of prescribing the right drug with the right dose and duration, to avoid any kind of abuse that may cause or increase antibiotic resistance.

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Are we running out of antibiotics? - Slideset by Professor Esposito

  1. 1. ARE WE RUNNING OUT OF ANTIBIOTICS? Susanna Esposito Pediatric Clinic, University of Perugia Perugia, Italy
  2. 2. Disclosures Research Grants: Abbott, DMG, GSK, Janssen, Sanofi-Pasteur, Vifor Advisory Board Membership: GSK, Janssen, MSD, Sanofi-Pasteur, Pfizer, Vifor
  3. 3. A very short life-span
  4. 4. Antibiotic Consumption, Europe OECD 2016
  5. 5. AMR, Europe OECD 2016
  6. 6. ANTIMICROBIAL RESISTANCE AND USE OF ANTIBIOTICS a) ABUSE: prescriptions for diseases not due to bacterial infection b) MISUSE: use with inappropriate dosage and duration of administration
  7. 7. Effect of antibiotic prescribing in primary care on antibiotic resistance (From Costelloe C et al. BMJ 2010)
  8. 8. MDR gram-negative bacilli, resistance mechanisms & therapeutic options Pop-Vicas A & Opal SM Virulence 2013
  9. 9. Prevention of infection: handwashing Early and late hand washing and emergence of respiratory infectious diseases (from Kim HS et al., Medicine 208)
  10. 10. Prevention of infections: use of vaccines Immediate reduction of IPD after conjugate vaccine introduction
  11. 11. Results of antibiotic stewardship programs in pediatrics (From Godbout EJ et al., Curr Infect Dis Report 2018)
  12. 12. DO NOT TREAT CONTAMINATION OR COLONIZATION!!!
  13. 13. Surgical prophylaxis • Surgical antimicrobial prophylaxis reduce the risk of SSI • Surgical antimicrobial prophylaxis timing is crucial • Prophylaxis should use narrow-spectrum antibiotic • Control of the adherence to the National Guidelines • National surveillance system of adverse events of antibiotic prophylaxis, including C. difficile • Communication and educational programmes to increase awareness of adverse events, including AMR, due to inappropriate use of antibiotics for surgical prophylaxis Menichetti F et al. Int J Antimicrob Agents. 2018 Aug;52(2):127-134
  14. 14. Medical prophylaxis in patients at risk of infections • Prevention of endocarditis in dental procedures • Prevention of post-splenectomy sepsis syndrome • Prevention of Rheumatic Fever • Prevention of relapsing cellulitis in lymphedema • Prevention in close contact of N.meningitidis • Prevention of sepsis in febrile neutropenia (?) • Prevention of sepsis in multi-colonized pts (?) Menichetti F et al. Int J Antimicrob Agents. 2018 Aug;52(2):127-134
  15. 15. Relationship between antimicrobial consumption & antimicrobial resistance in humans & animals
  16. 16. Antibiotic choice depending on genotype (Enterobacteriaceae) ESBL AmpC KPC OXA NDM Carbapenems Ceftazidime-avibactam Ceftolozane-tazobactam Cefepime Colistin Tigecycline Aminoglycosides Piperacillin/tazobactam Fosfomicina
  17. 17. Appropriate use of antimicrobials Surrogate markers: procalcitonin (PCT) • PCT help to identify bacterial infections • PCT-guided antibiotic therapy significantly reduce: days of antibiotic exposure, drug-related side-effects and rate of antibiotic resistance. • The early dynamic of PCT values (48-72 hrs) is a reliable predictor of survival and efficacy of antibiotic therapy. • PCT may help to distinguish between Gram-neg. & Gram-pos. infection and support the suspicion of fungal infection • Low PCT levels in sepsis suggest: deep abscesses, meningitis/ventriculitis, endocarditis, atypical pneumonia, etc. Menichetti F et al. Int J Antimicrob Agents. 2018 Aug;52(2):127-134
  18. 18. ANTIBIOTIC EXPOSURE BY TREATMENT GROUP AND CAP SEVERITY (From Esposito S et al., Resp Med 2011)
  19. 19. Potential US FDA approval of selected new antibiotics according to their perceived innovation potential (From Theuretzbacher U et al., Clin Microbiol Infect 2017)
  20. 20. Take home messages • AMR: a call for action • A multi-level committment (strong political advocacy and clear institutional engagement) • Multidisciplinary clinical governance • ASP for hospital and community setting • Synergism between scientific society & political/institutional level

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