This document discusses antibiotic resistance as a major public health challenge. It notes that at least 2.8 million antibiotic-resistant infections occur in the US each year, resulting in over 35,000 deaths. Antibiotic resistance develops when bacteria evolve and gain the ability to defeat drugs designed to kill them. This makes infections harder to treat and requires more costly and toxic alternatives. The brief history provided shows how bacteria developed resistance soon after the introduction of early antibiotics like penicillin. It also outlines some of the major antibiotic-resistant bacteria according to the CDC's 2019 threats report and strategies to curb further resistance through judicious antibiotic use and developing new drugs.

1. Antibiotic Resistance
By
Dr . Magdy Shafik Ramadan
Senior Pediatric and Neonatology consultant
M.S, Diploma, Ph.D of Pediatrics

2. Introduction
• Antibiotic resistance is one of the biggest public
health challenges of our time.
• Each year in the U.S., at least 2.8 million people
get an antibiotic-resistant infection, and more than
35,000 people die.
• Fighting this threat is a public health priority that
requires a collaborative global approach across
sectors. CDC is working to combat this threat.

3. • Antibiotic resistance happens when germs like
bacteria and fungi develop the ability to defeat the
drugs designed to kill them.
• Infections caused by antibiotic-resistant germs are
difficult, and sometimes impossible, to treat. In
most cases, antibiotic-resistant infections require
extended hospital stays, additional follow-up doctor
visits, and costly and toxic alternatives.

4. • No one can completely avoid the risk of resistant
infections, but some people are at greater risk
than others (for example, people with chronic
illnesses). If antibiotics lose their effectiveness,
then we lose the ability to treat infections and
control public health threats.
• Many medical advances are dependent on the
ability to fight infections using antibiotics,
including joint replacements, organ transplants,
cancer therapy, and treatment of chronic diseases
like diabetes, asthma, and rheumatoid arthritis.

5. Brief History of Resistance and Antibiotics
• Penicillin, the first commercialized antibiotic, was
discovered in 1928 by Alexander Fleming.
• In fact, germs will always look for ways to survive
and resist new drugs.
• More and more, germs are sharing their resistance
with one another, making it harder for us to keep
up.

6. Antibiotic Approved
or Released
Year
Released
Resistant Germ Identified Year
Identified
Penicillin 1941 Penicillin- resistant Staphylococcus
aureus
Penicillin-resistant Streptococcus
pneumoniae
Penicillinase-producing Neisseria
gonorrhoeae
1942
1967
1976
Vancomycin 1958 Plasmid-mediated vancomycin-
resistant Enterococcus faecium
Vancomycin-
resistant Staphylococcus
aureus
1988
2002
Amphotericin B 1959 Amphotericin B-
resistant Candida auris
2016
Extended-spectrum
cephalosporins
(Cefotaxime)
1980 Extended-spectrum beta-
lactamase-
producing Escherichia coli
1983

7. Antibiotic Approved
or Released
Year
Released
Resistant Germ Identified Year
Identified
Azithromycin 1980 Azithromycin-
resistant Neisseria
gonorrhoeae
2011
mipenem 1985 Klebsiella
pneumoniae carbapenemas
e (KPC)-
producing Klebsiella
pneumoniae
1996
Ciprofloxacin 1987 Ciprofloxacin-
resistant Neisseria
gonorrhoeae
2007
Caspofungin 2001 Caspofungin-
resistant Candida
2004

9. • Daptomycin
• Daptomycin injection is in a class of
medications called cyclic
lipopeptide antibiotics. It works by killing
bacteria.

10. INDICATIONS
• Complicated Skin And Skin Structure Infections
(cSSSI)
• Staphylococcus Aureus Bloodstream Infections
(Bacteremia) In Adult Patients, Including Those
With Right-Sided Infective Endocarditis, Caused
By Methicillin-Susceptible And Methicillin-
Resistant Isolates
• Staphylococcus Aureus Bloodstream Infections
(Bacteremia) In Pediatric Patients (1 To 17 Years
Of Age)

11. Antibiotic Resistance
• Defined as micro-organisms that are not inhibited
by usually achievable systemic concentration of an
antimicrobial agent with normal dosage schedule
and / or fall in the minimum inhibitory
concentration (MIC)

12. Why resistance is a concern
• Resistant organisms lead to treatment failure
• • Increased mortality
• • Resistant bacteria may spread in
Community
• • Low level resistance can go undetected •
Added burden on healthcare costs
• • Threatens to return to pre-antibiotic era
• • Selection pressure

13. Mechanism Antibiotic Resistance
• A)Intrinsic (Natural)
• B)Acquired Genetic Methods
• 1- Chromosomal Methods Mutations
• 2-Extra chromosomal Methods Plasmids

14. • Factors of Antibiotic Resistance
• 1-Drug Related Factors
• 2-Environmental Factors
• 3-Patient Related Factors
• 4-Prescriber Related Factors

15. 1-Drug Related Factors
• Over the counter availability of antimicrobials •
• Counterfeit and substandard drug causing suboptimal
blood concentration
• Irrational fixed dose combination of antimicrobials
• • Soaring use of antibiotics

16. 2-Environmental Factors
1. Huge populations and overcrowding •
• 2---Rapid spread by better transport facility •
• 3-Poor sanitation •
• 4-Increases community acquired resistance •
•
• 5-Ineffective infection control program

17. 3-Patient Related Factors
• Poor adherence of dosage Regimens •
• Poverty
• • Lack of sanitation concept
• • Lack of education
• • Self-medication
• • Misconception

18. 4-Prescriber Related Factors
• Inappropriate use of available drugs •
• Increased empiric poly-antimicrobial use •
• Overuse of antimicrobials
• • Inadequate dosing
•
• • Lack of current knowledge and training.

19. •
Where Antibiotic Resistance Spreads
• Healthcare Facilities
• Community
• Environment
• Food, Farms, & Animals

20. • Biggest Threats and Data
In 2013, CDC published the first AR Threats
Report, which sounded the alarm to the
danger of antibiotic resistance.
• The report stated that each year in the U.S.
at least 2 million people get an antibiotic-
resistant infection,
• and at least 23,000 people die.

21. • 2019 AR Threats Report
• more than 2.8 million antibiotic-resistant
infections occur in the U.S. each year,
• and more than 35,000 people die as a result.
• In addition, 223,900 cases of Clostridioides
difficile occurred in 2017 and at least 12,800
people died.
• The 2013 and 2019 reports do not include
viruses (e.g., HIV, influenza) or parasites.

22. • Bacteria and Fungi Listed in the 2019 AR
Threats Report
• Urgent Threats
• Carbapenem-resistant Acinetobacter
• Candida auris
• Clostridioides difficile
• Carbapenem-resistant Enterobacteriaceae
• Drug-resistant Neisseria gonorrhoeae

23. • Serious Threats
• Drug-resistant Campylobacter
• Drug-resistant Candida
• ESBL-producing Enterobacteriaceae
• Vancomycin-resistant Enterococci (VRE)
• Multidrug-resistant Pseudomonas aeruginosa
• Drug-resistant nontyphoidal Salmonella
• Drug-resistant Salmonella serotype Typhi
• Drug-resistant Shigella
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Drug-resistant Streptococcus pneumoniae
• Drug-resistant Tuberculosis

24. • Concerning Threats
• Erythromycin-Resistant Group
A Streptococcus
• Clindamycin-resistant Group
B Streptococcus

25. Strategies to contain resistance
• Develop new antibiotics
– Bypass the drug resistance
• Judicious use of the existing antibiotics:
– Containment of drug resistance

26. • New Antibiotic Development
• Only 15 antibiotics of 167 under
development had a new mechanism of
action with the potential to combat of
multidrug resistance.
• • Lack of incentive for companies to develop
antibiotics.

27. Alternate Approaches
• Phage therapy
• • Phage Therapy is the therapeutic use of
lytic bacteriophages to treat pathogenic
bacteria infections
• • Bacteriophages are viruses that invade
bacterial cells and disrupt bacterial
metabolism and cause the bacterium to lyse.
• Bacteriophage therapy is an important
alternative to antibiotics

28. • • The success rate was 80–95% with few
gastrointestinal or allergic side effects.
• British studies also demonstrated significant
efficacy of phages against Escherichia coli,
Acinetobacter spp., Pseudomonas spp and
Staphylococcus aureus

29. • Judicious Use of Antibiotics
• Can only contain antibiotic resistance •
• Cannot eliminate the possibility of antibiotic
development as resistance is an evolutionary
process

30. • Containment of antibiotic resistance is a
multi-pronged program
• Involves all stake holders
• – Physicans
• – Patients
• – Pharmaceuticals

31. Hospital Antibiogram
• A periodic summary of antimicrobial
susceptibilities of local bacterial isolates
submitted to the hospital's clinical microbiology
laboratory.
• • Used by clinicians to assess local susceptibility
rates, as an aid in selecting empiric antibiotic
therapy, and in monitoring resistance trends
over time within an institution

32. Hospital Antibiotic Policy
• To curb the common misuse and overuse of
antibiotics
• • Restricts the occurrence of antibacterial
resistance among the hospital strains
• • Controls the spread of such infections to
susceptible and critically ill patients in the
hospital and the subsequent infection into the
community.
• • Saves money for the patient and increases
patient satisfaction with decreased side effect

33. • In our hospital antibiotics
recommended
• Gm +ve bacteria
• First line Second line • •
Penicillin • vancomycin
• Oxacillin oflaxacin
• • Amoxy –Clav clindamycin
• • Cephalothin clarthromycin
• • Erythromycin linozolid
• • Cotrimoxazole
• • Ciprofloxacin
• • Gentamicin

34. In our hospital antibiotics recommended
• Gm -ve bacteria
First line Second line •
Amox-clav cefapime
Gentamicin impenium
Cipro toberamycin
Cefatizime
Cefazoline
Amikacin

35. In our hospital antibiotics
recommended
• MRESA
Topical Fusidic acid
• Vancomycin
• Teicoplanin
• Linezolid
• Minocycline
• Sparfloxacin
• Rifampicin

36. In our hospital antibiotics recommended
• P. Aeruginosa
• Piperacillin
• • Cefaperazone
• • Amikacin
• • Ciprofloxacin
• • Gatifloxacin
• • Tobramycin
• • Netilimycin
• • Cefipime
• • piperacillin –Tazobactum
• • Ceftazidime

40. THANK YOU