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Antibiotic resistances
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.
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Antibiotic resistances
- 1. Antibiotic Resistance By Dr .Magdy Shafik Ramadan Senior Pediatric and Neonatology consultant M.S, Diploma, Ph.D of Pediatrics
- 2. Introduction • Antibiotic resistanceis 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 resistancehappens 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 onecan 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 ofResistance 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 ResistantGerm 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 ResistantGerm 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 • Daptomycininjection is in a class of medications called cyclic lipopeptide antibiotics. It works by killing bacteria.
- 10. INDICATIONS • Complicated SkinAnd 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 • Definedas 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 isa 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 ofAntibiotic 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. Hugepopulations 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 ResistanceSpreads • Healthcare Facilities • Community • Environment • Food, Farms, & Animals
- 20. • Biggest Threatsand 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 ARThreats 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 andFungi 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 containresistance • Develop new antibiotics – Bypass the drug resistance • Judicious use of the existing antibiotics: – Containment of drug resistance
- 26. • New AntibioticDevelopment • 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 • Phagetherapy • • 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. • • Thesuccess 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 Useof Antibiotics • Can only contain antibiotic resistance • • Cannot eliminate the possibility of antibiotic development as resistance is an evolutionary process
- 30. • Containment ofantibiotic resistance is a multi-pronged program • Involves all stake holders • – Physicans • – Patients • – Pharmaceuticals
- 31. Hospital Antibiogram • Aperiodic 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 ourhospital 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 hospitalantibiotics recommended • Gm -ve bacteria First line Second line • Amox-clav cefapime Gentamicin impenium Cipro toberamycin Cefatizime Cefazoline Amikacin
- 35. In our hospitalantibiotics recommended • MRESA Topical Fusidic acid • Vancomycin • Teicoplanin • Linezolid • Minocycline • Sparfloxacin • Rifampicin
- 36. In our hospitalantibiotics recommended • P. Aeruginosa • Piperacillin • • Cefaperazone • • Amikacin • • Ciprofloxacin • • Gatifloxacin • • Tobramycin • • Netilimycin • • Cefipime • • piperacillin –Tazobactum • • Ceftazidime
- 40.