Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Mechanism Antibiotic Resistance
Intrinsic (Natural)
Acquired
Chromosomal
Extra chromosomal
Intrinsic Resistance
Lack target : No cell wall; innately resistant to penicillin
2. Drug inactivation: Cephalosporinase in Klebsiella
3. Innate efflux pumps:
It is an active transport mechanism. It requires ATP.
Eg. E. coli, P. aeruginosa
Altered target sites
PBP alteration
Ribosomal target alteration
Decreased affinity by target modification
Beta-lactamase
Beta-lactamases are enzymes produced by bacteria that provide resistance to β-lactam antibiotics such as penicillins, cephamycins, and carbapenems
Major resistant Pathogen
1. PRSP- Penicillin resistant Streptococcus pneumoniae2. MRSA/ORSA- Methicillin-resistant Staphylococcus Aureus (Super bug)3. VRE -Vancomycin-Resistant Enterococci4. Carbapenem resistant pseudomonas aeruginosa5. Carbapenem resistant Carbapenem resistant 6. Extended spectrum beta-lactamase (ESBL)-producing bacteria
Description of the major classes of antimicrobial drug, resistant mechanisms developed by bacteria to combat the action of antimicrobials, and the control measures needed to limit this horizontal gene transfer.
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Mechanism Antibiotic Resistance
Intrinsic (Natural)
Acquired
Chromosomal
Extra chromosomal
Intrinsic Resistance
Lack target : No cell wall; innately resistant to penicillin
2. Drug inactivation: Cephalosporinase in Klebsiella
3. Innate efflux pumps:
It is an active transport mechanism. It requires ATP.
Eg. E. coli, P. aeruginosa
Altered target sites
PBP alteration
Ribosomal target alteration
Decreased affinity by target modification
Beta-lactamase
Beta-lactamases are enzymes produced by bacteria that provide resistance to β-lactam antibiotics such as penicillins, cephamycins, and carbapenems
Major resistant Pathogen
1. PRSP- Penicillin resistant Streptococcus pneumoniae2. MRSA/ORSA- Methicillin-resistant Staphylococcus Aureus (Super bug)3. VRE -Vancomycin-Resistant Enterococci4. Carbapenem resistant pseudomonas aeruginosa5. Carbapenem resistant Carbapenem resistant 6. Extended spectrum beta-lactamase (ESBL)-producing bacteria
Description of the major classes of antimicrobial drug, resistant mechanisms developed by bacteria to combat the action of antimicrobials, and the control measures needed to limit this horizontal gene transfer.
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation
In the United States, an estimated 1.2 million Americans are living with chronic Hepatitis B and 3.2 are living with chronic Hepatitis C
Many do not know they are infected
Each year an estimated 21,000 persons become infected with Hepatitis A; 35,000 with Hepatitis B, and 17,000 with Hepatitis C
Hepatitis A – fecal/oral, contaminated food, vaccine available
Hepatitis B – blood, semen, vertical (mother-child), vaccine available
Hepatitis C – blood (IV drug use, transfusion, organ donation, unsterile injecting equipment, sexual intercourse)
Hepatitis D – survives only in cells co-infected with hepatitis B
Hepatitis E* – contaminated food or water, fecal/oral
*causes short-term disease and is not a chronic carrier state
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation
In the United States, an estimated 1.2 million Americans are living with chronic Hepatitis B and 3.2 are living with chronic Hepatitis C
Many do not know they are infected
Each year an estimated 21,000 persons become infected with Hepatitis A; 35,000 with Hepatitis B, and 17,000 with Hepatitis C
Hepatitis A – fecal/oral, contaminated food, vaccine available
Hepatitis B – blood, semen, vertical (mother-child), vaccine available
Hepatitis C – blood (IV drug use, transfusion, organ donation, unsterile injecting equipment, sexual intercourse)
Hepatitis D – survives only in cells co-infected with hepatitis B
Hepatitis E* – contaminated food or water, fecal/oral
*causes short-term disease and is not a chronic carrier state
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
In India, bacteria that cause common infections, such as urinary tract and bloodstream infections, are becoming resistant to nearly all antibiotics. This resistance is due to a combination of factors: uncontrolled access to antibiotics, gaps in infection prevention and control (IPC) practices, and high rates of communicable diseases. Antibiotic resistance, or AR, is a serious problem throughout the country, and threatens to reduce the usefulness of antibiotics both in India and around the world.
Because of this emerging threat, India is committed to slowing the spread of AR. Two institutions within India’s Ministry of Health – the Indian Council of Medical Research and National Centre for Disease Control – each developed national networks of public and private hospitals to measure AR trends, prevent healthcare-associated infections (HAIs), and enhance appropriate use of antibiotics. The All India Institute of Medical Sciences is coordinating HAI measurement and prevention efforts in both networks. In addition, efforts in the state of Tamil Nadu focus on building district-level IPC capacity to prevent HAIs, focusing on maternal and neonatal patients.
The Indian Governamnet is is working closely with partners at the national and state level to:
Detect AR pathogens, including novel strains, by developing lab networks and lab expertise.
Use standardized surveillance to monitor and track AR infections in healthcare to learn how often these infections occur and to help develop strategies to prevent them.
Implement focused IPC activities and training.
Optimize use and reduce misuse of critical antibiotics through antibiotic stewardship programs.
Combating Drug Resistance in The Intensive Care Unit (ICU)Apollo Hospitals
Drug resistance of microbes has become a major stumbling block to treating patients successfully in the ICU. There is no doubt that microbes have the capacity to mutate or acquire drug destroying enzymes, but a multitude of errors by health care providers plays a major role in facilitating the development of resistance. The maintenance of drug use discipline in closed ICUs and having a responsive microbiology department are the first steps towards prevention of microbe resistance. Having an infection control committee that is able to collect and disseminate data is the next essential step. Education of health care providers to provide uniformity of health care according to set guidelines is the culmination of this towards the goal of minimizing the development of anti microbial resistance.
Similar to An tibiotic policy in medical care seminar (20)
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Cardiac conduction defects can occur due to various causes.
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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).
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. Why we Need Antibiotics
Nearly One half of the Hospitalized patients
receive antimicrobial agents.
Antibiotics are valuable Discoveries of the Modern
Medicine.
All current achievements in Medicine are attributed
to use of Antibiotics
Life saving in Serious infections.
4. What went wrong with Antibiotic Usage
Treating trivial infections / viral Infections with Antibiotics
has become routine affair.
Many use Antibiotics without knowing the Basic
principles of Antibiotic therapy.
Many Medical practitioners are under pressure for short
term solutions.
Commercial interests of Pharmaceutical industry pushing
the Antibiotics, more so Broad spectrum and Newer
Generation antibiotics. as every Industry has become
profit oriented.
Poverty encourages drug resistance due to under
utilization of appropriate Antibiotics.
6. Basis of Antibiotic Resistance
The antibiotic resistance is guided by Genomic changes.
Spread of R plasmids among the Bacteria.
Do remember Antibiotics are used in Animal
husbandry apart from Medical use.
The discovery of antibiotic resistance was discovered
with spread of R plasmids from animal sources.
The Human gut forms the interconnecting area in R
plasmids transmission leading ultimately to antibiotic
resistance.
9. Spread of Antibiotic Resistance
Indiscriminate use of Antibiotics in Animals and
Medical practice.
R plasmids spread among co-inhabiting
Bacterial flora in Animals ( in gut ).
R plasmids may be mainly evolved in Animals
spread to Human commensal, - Escherichia coli
followed by spread to more important human
pathogens E.g. Shigella spp.
10. Antibiotic Use and Emergence of
Resistance
MRSA
Methicillin Resistant Staphylococcus Aureus
Ciprofloxacin
Cephalosporins
Other Beta-lactams
13. Evidence is Overwhelming
Change of antibiotic prescribing and
antibiotic policy and reduction and
control of emergence of resistant
organisms and HCAIs and their spread.
14. Red Alert Action Plan
to Reduce C. diff Infections
Antibiotic prescribing
Hand washing
Signage
Patient flow
Isolation procedures
Cleaning of environment
Cleaning of medical equipment
Education and training
16. Antibiotic Policy
Withdrawal of 3rd generation cephalosporins.
More rigorous restriction of certain
antibiotics.
Encourage use of oral antibiotics.
Switching from i/v to oral within 24-48 hrs.
Duration not exceeding 5 days.
17. Ensuring Adherence to Antibiotic
Policy
Daily antibiotic surveillance.
Clinical Pharmacist.
Drug chart.
ICNs and ward nurses.
Clinical audit.
Education and training
19. Aim of Antibiotic Policy
Reduce the Antimicrobial resistance.
Initiate best efforts in the hospital area as many
resistance Bacteria are generated in Hospital areas and
in particular critical care areas.
Initiate good hygienic practices so these bacteria do not
spread to others.
Practice best efforts, these resistance strains do not spill
into critically ill patients in the Hospital.
To prevent spill into Society, as they present as
community associated infections..
20. Spread of HCAIs.
Better use of resources.
Improve education of junior doctors
Local policy more effective than national
Aim of Antibiotic Policy contd.
21. Evidence for Policy
Randomised controlled trials ??
Descriptive and analytical studies
Expert opinion
22. Objectives of Antibiotic Policy.
Antibiotics should not be used casually.
Policy emphasizes, avoiding the use of powerful
Antibiotics in the Initial treatments.
We should create awareness that we are
sparing the powerful Broad spectrum Drugs for
later treatment
Patient saves Money
Doctors save Lives.
23. Antibiotic Policy Deals with :
We discuss on the Broad basis
Clinicians / Microbiologists / Clinical
Pharmacologist / Pharmacists and Nurses do
take part.
Policies are framed on demands of the Clinical
areas, depending on recent Infection
surveillance data contributed from Microbiology
Departments.
24. Aims of the Antibiotic Policy
Create awareness on Antibiotics as misuse is
counterproductive.
More effective treatments in serious Infections.
Reduce Health care associated infections
spilling to society and increase of Community
associated Infections.
( A growing concern in Developing world )
25. Antibiotic working Group Monitors
Formulate Optimal guidelines in Treatment
of Infections with minimal risk of Health care
associated Infections.
Create a plan for monitoring the Use of
Antibiotics across the Hospital
26. Education On Antibiotic policy
Acton plan for Education to all concerned clinical staff on
Antibiotic prescriptions.
Evaluate the feed back of success and failures of the policy.
Create Infection surveillance Data.
Developing facilities in Microbiology departments for auditing
data and guidance.
Restrictions in prescribing and Antibiotic availability.
A continuous education to Junior Doctors.
Regular interaction with clinical pharmacologist.
27. Proactive Engagement of
Microbiologist
List of patients on i /v antibiotics faxed to
Microbiology daily.
Microbiologist contact clinicians and agree
on antibiotic management plan.
This has led to reduction in use of broad –
spectrum antibiotics.
28. Role of Microbiologist and
Microbiology Department
Inform antibiotic policy.
Restrict antibiotic reporting.
Disseminate to all clinical areas types of
isolates and their sensitivity patterns.
Appropriate advice on the report.
29. Sample collection
Proper specimen collection is combined
responsibility of Clinical and Microbiological
Departments.
Continuous training of junior staff on sample
collection, and is most neglected necessity.
A good clinical history is greatly helpful in
differentiating community acquired
infections from hospital acquired infections.
30. Pitfalls in Specimen collection
A proper specimen
collection is most
neglected area of
Microbiology.
Scientific approaches in
Sample collection is
concern for successful
Microbiological
evaluations,
31. Microbiology Services
Constant up
graduation of
Microbiology
departments is good
investment.
Quality control
methods in testing of
antibiotic resistance
pattern is a top
priority.
32. Role of Microbiology Department
Microbiology departments asses trends in
development of antimicrobial resistance.
The results of sensitivity/resistance patterns
should be correlated with Antimicrobial
agents currently used in the Hospital.
Identify and forecast that nature of relation
between antibiotic use and resistance.
33. Better services from Microbiology
Department.
Basic infrastructure
should be updated for
detection of MRSA and
ESBL producers.
Documentation of all
Opportunistic infections.
and Hospital infection
outbreaks
35. Empherical Therapy
To many drugs
creates complex
problems in drug
resistance.
The clinicians should
optimize the duration
of empherical
treatment.
36. Advantages of Antibiotic Policy
Saves the Lives.
Reduces the morbidity.
Saves Health related costs.
Reduces the Antibiotic related toxicity.
Patients are satisfied.
37. Staff Education on Antibiotic Policy
Staff education is most Important principle in
success.
Draw your own plans according to nature of patients,
your past experiences.
Induction training for new staff.
Continuing Medical Education to both Junior and
Senior practitioners.
Include nursing staff, pharmacists for the success of
the Programme
38. Patient Education on Antibiotic
Policy
Education of the patients and society is
important in Devloping world.
Educate the patients many infections are
trival,viral, Do not need Antibiotics
If they understand Unnecessary
consumption of Antibiotics kills the Normal
flora, and reduces the Immunity and makes
them potential victims in future.
A difficult task in Devloping countries.
39. Our Policy is Successful
If the Staff will understand the potential hazards
of Antibiotics.
Use of Antibiotic guidelines in teaching Under
and Post graduate Medical Students,
If we are united we can reduce Hospital
generated infections.
40. We will succeed with Antibiotic Policy
If
Both patients and Doctors reduce their
expectation on the role of Antibiotics.
If the Medical profession realizes our aim is
to give Right Drug for Right Bug.
41. Proved success of Antibiotic
Policies
Studies Prove
1 Rapid reversal of major clinical problems of resistance to
Choramphenicol ,Erythromycin, and Tetracycline in Staphylococcus
aureus on withdrawal of antibiotics.
2 Out breaks of Erythromycin resistant Group A Streptococci and
Penicillin resistant Pneumococci, can be controlled by major
reduction in prescription of Erythromycin and Penicillin.
3 Control of multiple resistant Gram – ve bacteria and role played
by reducing the prescription of 3rd generation of Cephalosporins.
.
( I.M.Gould Review of the role of antibiotic policies in the control
of antibiotic resistance, Journal of Antimicrobial Chemotherapy
1999 43, 459 – 465. )
42. Make your conclusions and
contribute to Antibiotic Policy
It is true to say that there is no absolute proof of
causative association between antibiotic use and
resistance, But many authorities believe the
association to be virtually certain.
It is pragmatic and essential approach to control of
antibiotic resistance with control of antibiotic use.
Make every one a partner in prevention of Antibiotic
resistance, and success will follow.
43. How to prove the Success
Prove your action plans with evidence based
success outcomes.
Senior practitioners should be role models.
Prove how rationalism helps, saves money,
morbidity and mortality.
44. Why Everyone worried about
Antibiotic ( misuse ) Use.
Drug resistance can reverse Medical progress
The following diseases are already in the list of
attaining the drug resistance, and Medical
profession will find difficult to cure in future.
1. Tuberculosis
2. Malaria
3. Sore throat and Ear Infections.