Basic laboratory procedures in clinical bacteriologyamin beni
book of Basic laboratory procedures in clinical bacteriology Basic laboratory procedures in clinical bacteriology Basic laboratory procedures in clinical bacteriology Basic laboratory procedures in clinical bacteriology
Pharmaceutical Microbiology: Current and Future Challenges Tim Sandle, Ph.D.
The changing environment for pharmaceutical microbiology
Limitations of methods
Need for new (rapid) methods
Separating people form processes
Single-use technologies
Environmental monitoring programme
Best practices
Rapid methods
Contamination control strategy
Objectionable organisms
Burkholderia cepacia complex
Basic laboratory procedures in clinical bacteriologyamin beni
book of Basic laboratory procedures in clinical bacteriology Basic laboratory procedures in clinical bacteriology Basic laboratory procedures in clinical bacteriology Basic laboratory procedures in clinical bacteriology
Pharmaceutical Microbiology: Current and Future Challenges Tim Sandle, Ph.D.
The changing environment for pharmaceutical microbiology
Limitations of methods
Need for new (rapid) methods
Separating people form processes
Single-use technologies
Environmental monitoring programme
Best practices
Rapid methods
Contamination control strategy
Objectionable organisms
Burkholderia cepacia complex
In the era of modern technology, health care delivery system involves so many different personnel and specialties that the caregiver must have an understanding and working knowledge of other professional endeavors, including the role of diagnostic evaluation.
Basically, laboratory and diagnostic tests are tools by and of themselves, they are not therapeutic.
In conjunction with a pertinent history and physical examination, these tests can confirm a diagnosis or provide valuable information about a patient status and response to therapy.
In addition to these, laboratory findings are essential for epidemiological surveillance and research purposes.
If the entire network of a laboratory service is to be effectively utilized and contribute to health care and disease prevention, every member of its work force need to:
Understand the role of the laboratory and its contribution to the nation’s health service;
Appreciate the need to involve all members in the provision of health service;
Follow professional ethics and code of conduct;
Experience job satisfaction and have professional loyalty.
Medical laboratory science is a complex field embracing a number of different disciplines such as
Microbiology,
Hematology,
Clinical Chemistry,
Urinalysis,
Immunology,
Serology,
Histopathology,
Immunohematology and
Molecular biology and others
The Organization for Economical and Co-operation Development was used for testing of chemicals.
The original OECD guideline 451 for carcinogenecity study was adopted in 1981.
A Major carcinogenicity study is done on rodents
Mainly there routes of administration: oral, dermal, and inhalation.
Presentation from the International Life Sciences Institute, India - "Scientific Workshop on Safety Assessment of GM Foods" held on 14-15 October, 2015 in New Delhi, India
ISO 10993-3: Biological Evaluation of Medical Devices - Tests for Genotoxicit...NAMSA
ISO 10993-3: Biological Evaluation of Medical Devices discusses how to identify when genotoxicity, carcinogenicity or reproductive toxicity testing is necessary for a medical device.
Evaluation of various /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
2nd Annual Infection Control, Sterilization and Decontamination in Healthcare...Tony Couch
After the success of inaugural congress held on 25th-26th February 2016, MnM Conferences is organizing 2nd Annual Infection Control, Sterilization and Decontamination in Healthcare Congress, scheduled for 21st & 22nd March 2017 in London, UK aiming at providing platform to experts from hospitals, academia, and government institutions discussing the innovations, challenges, and future aspects of infection control, decontamination, and sterilization.
Fighting the growing threat of antimicrobial resistance webinar4 All of Us
Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).
Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.
In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.
This webinar will focused on the importance of understanding the need for diagnostics, what is being done in development and the solutions that are available now.
In the era of modern technology, health care delivery system involves so many different personnel and specialties that the caregiver must have an understanding and working knowledge of other professional endeavors, including the role of diagnostic evaluation.
Basically, laboratory and diagnostic tests are tools by and of themselves, they are not therapeutic.
In conjunction with a pertinent history and physical examination, these tests can confirm a diagnosis or provide valuable information about a patient status and response to therapy.
In addition to these, laboratory findings are essential for epidemiological surveillance and research purposes.
If the entire network of a laboratory service is to be effectively utilized and contribute to health care and disease prevention, every member of its work force need to:
Understand the role of the laboratory and its contribution to the nation’s health service;
Appreciate the need to involve all members in the provision of health service;
Follow professional ethics and code of conduct;
Experience job satisfaction and have professional loyalty.
Medical laboratory science is a complex field embracing a number of different disciplines such as
Microbiology,
Hematology,
Clinical Chemistry,
Urinalysis,
Immunology,
Serology,
Histopathology,
Immunohematology and
Molecular biology and others
The Organization for Economical and Co-operation Development was used for testing of chemicals.
The original OECD guideline 451 for carcinogenecity study was adopted in 1981.
A Major carcinogenicity study is done on rodents
Mainly there routes of administration: oral, dermal, and inhalation.
Presentation from the International Life Sciences Institute, India - "Scientific Workshop on Safety Assessment of GM Foods" held on 14-15 October, 2015 in New Delhi, India
ISO 10993-3: Biological Evaluation of Medical Devices - Tests for Genotoxicit...NAMSA
ISO 10993-3: Biological Evaluation of Medical Devices discusses how to identify when genotoxicity, carcinogenicity or reproductive toxicity testing is necessary for a medical device.
Evaluation of various /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
2nd Annual Infection Control, Sterilization and Decontamination in Healthcare...Tony Couch
After the success of inaugural congress held on 25th-26th February 2016, MnM Conferences is organizing 2nd Annual Infection Control, Sterilization and Decontamination in Healthcare Congress, scheduled for 21st & 22nd March 2017 in London, UK aiming at providing platform to experts from hospitals, academia, and government institutions discussing the innovations, challenges, and future aspects of infection control, decontamination, and sterilization.
Fighting the growing threat of antimicrobial resistance webinar4 All of Us
Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).
Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.
In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.
This webinar will focused on the importance of understanding the need for diagnostics, what is being done in development and the solutions that are available now.
Latest Updates in Biosafety Testing for Gene TherapyMilliporeSigma
The field of Gene Therapy is moving at a fast pace providing promise of lifesaving medicines to previously unmet clinical needs. Of significant importance in the development of these novel therapies is the ability to demonstrate their safety including freedom from adventitious agents originating from raw materials or introduced during the manufacturing process.
It can be challenging, in such a fast moving field, to identify and navigate the relevant regulatory requirements and expectations for biosafety testing of such therapies. So too it can be difficult to select the optimal test methods in light of limited product availability and shelf life. Encompassing current biosafety testing approaches for bacteria, fungi, mycoplasma and viruses on starting materials to drug product, this webinar will provide you with the fundamentals to design your own Gene Therapy testing strategy.
In this webinar, you will learn:
• The most up to date regulatory expectations for Gene Therapies
• How to design a testing strategy to meet US FDA and EMA requirements
• How selecting the right biosafety test can overcome some of the unique challenges with Gene Therapies
The field of Gene Therapy is moving at a fast pace providing promise of lifesaving medicines to previously unmet clinical needs. Of significant importance in the development of these novel therapies is the ability to demonstrate their safety including freedom from adventitious agents originating from raw materials or introduced during the manufacturing process.
It can be challenging, in such a fast moving field, to identify and navigate the relevant regulatory requirements and expectations for biosafety testing of such therapies. So too it can be difficult to select the optimal test methods in light of limited product availability and shelf life. Encompassing current biosafety testing approaches for bacteria, fungi, mycoplasma and viruses on starting materials to drug product, this webinar will provide you with the fundamentals to design your own Gene Therapy testing strategy.
In this webinar, you will learn:
• The most up to date regulatory expectations for Gene Therapies
• How to design a testing strategy to meet US FDA and EMA requirements
• How selecting the right biosafety test can overcome some of the unique challenges with Gene Therapies
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Introduction: Bloodstream infections (BSIs) are associated with a high mortality rate of 20%-50%. Blood culture is paramount to identify causative agents of BSIs to choose an appropriate antimicrobial therapy. Objectives: The present study was undertaken to analyze the various microorganisms causing BSIs and study their antimicrobial resistance patterns in a tertiary care hospital, Eastern India. Materials and Methods: A total of 239 blood specimens from clinically suspected cases of BSIs were studied for 6 months from July 2015 to December 2015. Blood specimens were incubated in BacT/ALERT ® 3D system (bioMerieux, Durham, NC, USA) a fully automated blood culture system for detection of aerobic growth. Identification and antimicrobial susceptibility testing were conducted on VITEK ® 2 (bioMerieux, Durham, NC, USA) as per Clinical Laboratory Standards Institute guidelines. Results: Out of 239 specimens, 41 (17.2%) yielded growth of different microorganisms. From these isolates, 20 (48.8%) were Gram-negative bacilli, 18 (43.9%) were Gram-positive cocci and rest 3 (7.3%) were yeasts. Among Gram-negative bacilli, Klebsiella pneumoniae sub spp. pneumoniae (70%) was most commonly isolated. Coagulase-negative staphylococci (88.9%) were the most common isolate among Gram-positive cocci. All three Candida spp. isolated were nonalbicans Candida (two Candida tropicalis and one Candida krusei). Gram-negative isolates were least resistant to tigecycline and colistin. All Gram-positive cocci were sensitive to linezolid. Conclusion: Monitoring of data regarding the prevalence of microorganisms and its resistance patterns would help in currently prescribing antimicrobial regimens and improving the infection control practices by formulating policies for empirical antimicrobial therapy.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
4. 22.01.2018
4
Infections caused by true pathogens
• Single causative agent
• Characteristic clinical findings
• Diagnosis based on clinical
findings
• Treatment based on clinical
diagnosis
• Laboratory – confirmation of
diagnosis, epidemiology
• Developed countries
(prophylaxis)
• Ex. diphteria, tetanus, plague
etc
True pathogens are capable of causing
disease in healthy persons with normal
immune defenses
Opisthotonus in a patient suffering from
tetanus
Infections caused by opportunistic
pathogens
• Different causative agents
– Patient’s own microbes
– Hospital microbes etc
• Treatment directly
dependent on lab results
(ID, AMR testing)
• Developed countries
• Ex. sepsis, hospital acquired
pneumonia etc
Opportunistic pathogen‐ cause disease when
the host's defenses are compromised or when
they grow in part of the body that is not
natural to them
5. 22.01.2018
5
The goal of the Lab of clinical microbiology
• Correct treatment of infectious diseases
– Identification of infectious agents
– AMR testing
• Outbreak prevention
– Early detection of infected patients and
microbial carriers
– Epidemiologic surveillance
the ongoing and systematic collection, analysis,
and interpretation of health data
The goal of AM susceptibility testing
• Predict the in vivo success or failure of
antibiotic therapy
• In vitro tests under standardized conditions
• Test results combined with clinical information
• Selection of the most appropriate antibiotic
for the patient
6. 22.01.2018
6
Interpretation of susceptibility test
results
• Interpretive criteria for MIC/zone diameter of all
relevant antibiotics for most bacterial genera
1. microbiologic data (comparison of MIC/zone sizes on
a large number of bacterial strains)
2. pharmacokinetic/pharmacodynamic data
3. clinical studies results
(comparisons of MIC/zone diameter
with microbiological eradication and
clinical efficacy)
reviewed and updated
European Committee on Antimicrobial Susceptibility Testing
Breakpoint tables for interpretation of MICs and zone diameters
Version 7.1, valid from 2017‐03‐10
Clinical breakpoints are for everyday use in the clinical laboratory to advise on patient therapy.
8. 22.01.2018
8
Culture based microbiology
• 3rd day
Molecular microbiology
• Identification
• Resistance gene testing
– Methicillin R – mecA, mecC
– VRE – vanA, vanB
– ESBL (carbapenemases, AmpC)
• Rapid, sensitive, specific
• Higher cost, limitations
• Cannot replace phenotypic AMR testing
9. 22.01.2018
9
For good laboratory practice
• Verification – a one‐time process completed before a
test or instrument is used for patient testing. The
performance characteristics being verified can include
sensitivity, specificity, precision, accuracy, and
predictive value
• Validation – once an instrument or test system has
been verified, validation demonstrates that it
repeatedly continues to give the expected results as
performed over time and continues to meet the
manufacturer’s claims
covers the complete analytical process – preanalytical,
analytical and postanalytical
Guidelines and standards
13. 22.01.2018
13
• AMR testing in routine ID diagnostics is a
complex process
• Science based
• Standardized
Sucsessful ID management
Patient
Society
14. 22.01.2018
14
Usage of AMCs in health‐care
settings
Hospital environment
• A link between microbial surface
contamination and infection was first
identified in the 1960s and the role of surfaces
in cross‐contamination has now been well
documented
• The hospital environment has been identified
as an ideal ‘reservoir’ for micro‐organisms
17. 22.01.2018
17
Common modes of transmission from inanimate
surfaces to susceptible patients
AMC
AMC
Antimicrobial surfaces (copper, silver, organosilane,
triclosan, QAC etc)
AMC could help to reduce the rate of HAIs.
Antimicrobial surfaces in hospitals
• How do we test – and compare efficacy – of
antimicrobial surfaces?
• ISO 22916 – Antimicrobial products – Test for
antimicrobial activity and efficacy 2011
• Standardized tests have been proposed, but
not adopted widely Ojeil et al 2013; Agnihotri et al
2014
Intrinsic
resistance/tolerance
18. 22.01.2018
18
Acquired biocide resistance/tolerance
Acquired resistance/tolerance
Grey: sil‐positive isolates; white: sil‐negative isolates.
Swedish healthcare system ‐ restricted consumption of
silver‐based products
Risk group ‐ haematology and oncology patients
High frequency of silver resistance genes in invasive
isolates of Enterobacter and Klebsiella species
Sütterlin et al 2017 JHI
Phenotypical
resistance to
silver nitrate
13% Enterobacter
3% Klebsiella isolates.
single mutational event in
the silS gene
752 blood isolates
19. 22.01.2018
19
Acquired resistance/tolerance
Tolerance to quaternary ammonium compound disinfectants
may enhance growth of Listeria monocytogenes in the food
industry.
Møretrø et al 2017 JIFM
growth advantage at concentrations
of QAC present after sanitation
680 L. monocytogenes isolates
efflux genes qacH and bcrABC
increased tolerance to QAC
bcrABC ‐, qacH‐
bcrABC +, qacH+
0.001% of the benzalkonium chloride
based disinfectant DesQA.
2522 publicly available completely
sequenced bacterial genomes
565 different genera
Copper, silver, arsenic, antimony, cobalt, nickel, cadmium, iron, zinc, mercury and QACs
are all potential co‐selectors for strains resistant to, e.g.
sulfonamides, beta‐lactams, amphenicols, tetracyclines and aminoglycosides.
BMRG and ARG (horizontally transferrable)
Only ARGs
Only BMRG
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The result of biocide resistance/tolerance
• Microbes survive
• Growth advantage
• Co‐resistance with AB
AB vs AMC
Antibiotics AMC
Administration/application Living Inanimate
topical environmental surfaces
oral invasive devices
i/v etc
Target Specific Non‐specific
Task Treatment Prevention
Prevention
Routine AMR testing Yes No
Standards Yes No
Resistance surveillance Yes No
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AB vs AMC
Antibiotics AMC
Administration/application Living Inanimate
topical environmental surfaces
oral invasive devices
i/v etc
Target Specific Non‐specific
Task Treatment Prevention
Prevention
Routine AMR testing Yes No
Standards Yes No
Resistance surveillance Yes No
Conclusions
• Antibiotics are beneficial
• AMCs are beneficial
• To keep them beneficial in the future we need
– Research (basic & applied)
– Routine surveillance
– Dissemination of knowledge
