Antimicrobial resistance (AMR) occurs when microorganisms change when exposed to antimicrobial drugs, becoming 'superbugs' that medicines become ineffective against, allowing infections to persist and spread. This threatens global health by making infections difficult to treat, increasing mortality and healthcare costs. The top 10 most dangerous antibiotic resistant bacteria are described, along with factors contributing to AMR like overuse and misuse of antibiotics in humans, agriculture, personal care products and the environment. Additional precautions are needed when treating infections from antibiotic resistant bacteria. Public measures like handwashing and not sharing personal items can help reduce spread.

3. • AMR - Happens when microorganisms change
when they are exposed to antimicrobial drugs
• “superbugs” - Microorganisms that develop
antimicrobial resistance
• As a result,
Medicines become ineffective
Infections persist in the body
 Increasing the risk of spread to others.

4. • Reduction in the effectiveness of medicines
• Making infections and diseases difficult or impossible
to treat
• Increased mortality
• Prolonged illnesses in people and animals, production
losses in agriculture, livestock and aquaculture.
• Threatens global health, livelihoods and food security
• Increases the cost of treatments and care

5. • Emerging New resistance mechanisms
• Without effective - prevention and treatment of infections,
medical procedures such as organ transplantation, cancer
chemotherapy, diabetes management and major surgery - high
risk
• Increases the cost of health care with lengthier stays in hospitals
and more intensive care
• Puts the gains of the Millennium Development Goals at risk and
endangers achievement of the Sustainable Development Goals.

10. 10 most dangerous antibiotic-resistant bacteria

11. Streptococcus pyogenes
First Documented: 1884
Illness Caused: Sore throat, skin disorders
Antibiotic Resistance: Low
Virulence: Deadly
• Found in 5 per cent - 15 per cent of all humans
• Residing in the lungs or throat without causing any harm.
• Causes over 700 million infections globally every year and has a
high mortality rate of 25 per cent in serious cases
• Cause diseases ranging from sore throat and impetigo up to scarlet
fever.
•Luckily, the bacteria is affected by penicillin so is treated easily in
most cases - however several strains are building resistance to
various other antibiotics.

12. Neisseria gonorrhoeae
First Documented: 1885
Illness Caused: Gonorrhoea
Antibiotic Resistance: Medium
Virulence: Worrying
• Spread through sexual contact and causes various infections
in both men and women.
•Certain strains of the bacteria have shown resistance to
antibiotics and have mutated over the course of 50 years or so,
slowly adapting different resistances as doctors change their
approach by using different antibiotics to counter the disease.

13. Mycobacterium tuberculosis
First Documented: 1882
Illness Caused: Tuberculosis
Antibiotic Resistance: Medium
Virulence: Deadly
• Know by many names including scrofula and the White Plague and
has been a huge cause of death and distraction throughout history,
with evidence found in bodies estimated to be around 9,000 years
old.
•It is believed that Nefertiti and her Pharaoh husband Akhenaten
both died from tuberculosis in around 1330 BC, and documents
remain from ancient Egypt that talk of the dangers of the disease.
• The increase in antibiotic resistance has seen a rise in cases in the
early 90s.

14. Acinetobacter baumannii
First Documented: 1911
Illness Caused: Pneumonia, Meningitis, Urinary Tract Infection
Antibiotic Resistance: High
Virulence: Worrying
• Can survive in harsh conditions for long periods of time so
are often difficult to deal with in weaker patients, and coupled
with increasing resistance presents a tough challenge when
encountered by doctors. Sometimes called Iraqibacter
• Acinetobacter baumannii became very prevalent during the
Iraq war amongst injured soldiers who passed through several
different medical facilities.

15. Escherichia coli (E.coli)
First Documented: 1895
Illness Caused: Diarrhoea, Urinary Tract Infection, Meningitis
Antibiotic Resistance: High
Virulence: Worrying
• Completely harmless and survives happily in the human digestive
system. However, some strains of E.coli can cause serious illness and
most commonly lead to severe food poisoning as well as meningitis
and infections.
•A high level of resistance to antibiotics has been found across
several strains of E.coli and while it is rare to find these strains
causing illness, it is another concerning example of a bacteria that
has the potential to cause problems if our use of antibiotics goes
unchecked.

16. Klebsiella pneumoniae
First Documented: 1886
Illness Caused: Lung infections, Pneumonia
Antibiotic Resistance: Medium
Virulence: Worrying
• Cause a range of infections and has proven to be very
resistance to a range of antibiotics. Primarily affecting middle-
aged and older men with weakened immune systems, this
bacteria can be dangerous but is mostly ‘opportunistic’ and is
far less likely to affect healthy adults.
•This bacteria is still of concern across the globe.

17. Clostridium difficile
First Documented: 1935
Illness Caused: Diarrhoea
Antibiotic Resistance: Low
Virulence: Dangerous
•One of the better known ‘superbugs’ because of a consistent
presence in hospitals around the world, C.difficile is, primarily,
an easily spread type of diarrhoea that can lead to
complications in the colon.
•The bacteria is responsible for a significant number of deaths
globally.

18. Pseudomonas aeruginosa
First Documented: 1872
Illness Caused: Pneumonia, Various Infections
Antibiotic Resistance: Medium
Virulence: Worrying
•Quick to mutate and adapt to counter different antibiotic
treatments an innate ability to develop resistance to antibiotics.
•‘opportunistic’ because it primarily affects humans that are
already critically ill, this bacteria can cause serious complications
in the treatment of AIDS, cancer or cystic fibrosis patients.
•While it isn’t a massive threat to humanity currently, this
bacteria will become an increasing threat over the next few
years.

19. Burkholderia cepacia
First Documented: 1949
Illness Caused: Pneumonia
Antibiotic Resistance: Low
Virulence: Worrying
Discovered in 1949 as the bacterium that causes onions to rot,
Burkholderia cepacia can be very dangerous to humans in the worst
cases. While it mostly responds well to treatment with a
combination of antibiotics, it has been shown to have high levels of
resistance to several types of antibiotics and is able to survive in
extreme conditions. Particularly dangerous to humans with
preexisting lung conditions such as Cystic Fibrosis (link is external),
scientists have been developing new ways to fight the bacteria as it
evolves an increasing resistance to antibiotics.

20. Staphylococcus aureus (MRSA)
First Documented: 1884
Illness Caused: Pneumonia, Flesh Eating Disease
Antibiotic Resistance: Medium
Virulence: Dangerous
More commonly known as MRSA (which stands for Methicillin-
resistant Staphylococcus aureus), this ‘superbug’ is very easily spread
through human contact and can cause a range of illnesses from skin
disorders to deadly diseases like meningitis and pneumonia. Most
often treated with Penicillin type antibiotics, by 1960, 80 per cent of
hospital samples were antibiotic resistant. A concerted effort in
tracking the disease and improving hygiene measures in hospitals has
seen cases of MRSA fall by 84.7 per cent in the UK between 2003 and
2011 (link is external), proving that prevention is often the best form of

21. WHO PRIORITY PATHOGENS LIST FOR
R&D OF NEW ANTIBIOTICS

24. • Resistance due to misuse
• Poor control measures
• Immunization
• Counterfeiting of Drugs
• Health system factors
• Agricultural Use
• Hygienic Purpose
• Pharmacies
• Antibiotics in the Environment

25. • India was the world’s major consumer of Antibiotics
for human use
• 23% of increased sales were contributed by India while
China accounted for 57% of the rise in antibiotic sales in
the hospital sector
• Self – Medication
• Sales promotion schemes provided by pharmaceutical
manufacturers

26. • Poor Health due to Poverty
• Poor sanitation and cleanliness
Rate of access to improved sanitation facility
Brazil (81%)
China (65.3%)
Indonesia (58.8%)
While India only 36.6%

27. • Only 72% of the population are immunized
against Diphtheria-Tetanus- Pertussis
•85% - Indonesia
•99% - China

28. • Wrong compounds
•Lower concentration of active ingrediants
•Expired or lower grade API
Results in,
Sub-inhibitory or sub-therapeutic antiobiotic
concentration – induce resistance by genetic modifications
in the target bacteria

29. Improper Diagnosis
Inadequate equipped diagnostic laboratories –
Misguide physician – Wrong antibiotics being
prescribed

30. Trainee or New RMP
Might over prescribe drug – under the
influence of pharma company – attractive
rewards – lack of confidence – prepressure
CCU/ICU
Area were resistance problem occur – intense
of antibiotic use – use for prolonged
period – multiple antibiotics
Given – unclear infectious
disease

31. Industries and Scale up plants
• Rise in bulk API manufacturing and formulation
plants – last 10 years
• Disposing antimicrobial waste – directly into water
resources – develops resistance in the bacteria present
in it
• Several metric tons of antibiotics were released into
the biosphere (over the last 50 years)
• Cause physiological damage to the residents, insect,
birds and animals

32. •Selective evolution of powerful resistant strains in all
the bacterial genera inhabiting the river and
surrounding soil
• Workers working in packaging and crystallization –
prone to resistance

34. Agricultural Use
• Antibiotics used as growth supplement in livestock
• 90% of the antibiotics given to animals spread from
stools to fertilizer and surface runoff, ground water and
urination

36. Hygenic Purpose
• Antibiotics used in personal hygiene products
provides exposure of microbesin enviroment to growth
inhibitors
Pharmacies
Dispensing Loose antibiotics

45. Additional precautions with antibiotic
resistant bacteria
Micro-organisms may be classed as ‘high risk’ if:
• Their transmission route makes them more contagious – they
may be spread through contact or droplets, or may be airborne
• They are caused by antibiotic resistant bacteria
• They are resistant to standard sterilization procedures.
• Additional precautions are tailored to the particular pathogen
and route of transmission. Additional precautions may include:
• Use of a single room with ensuite facilities or a dedicated toilet
• Dedicated care equipment for that person
• Restricted movement of the person and their healthcare
workers.

46. Take Home Message
•Wash hands
•Cover your nose and mouth when coughing and sneezing.
•Use tissues to blow or wipe your nose.
•Dispose of tissues properly, either in the rubbish or toilet.
•Do not spit.
•Stay at home if you are unwell and cannot manage the normal
requirements of your day.
•Do not send children to child care, kindergarten or school if
they are unwell.
•If you are prescribed antibiotics, take the entire course
•If you continue to feel unwell, go back to the doctor.
•Avoid use of products that advertise they contain antibiotics, or
are antibacterial or antimicrobial, unless advised to do so by
your health professional.