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Antimicrobial resistance for clinicians
The document outlines a course on antimicrobial resistance aimed at clinicians, emphasizing the urgent need to address drug-resistant pathogens. It highlights core competencies for appropriate antimicrobial prescribing, mechanisms of resistance, and the implications of resistance for patient outcomes. Clinical case evaluations and guidelines for treatment illustrate the importance of evidence-based practices in combating antimicrobial resistance.
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Antimicrobial resistance for clinicians
- 1. Antimicrobial resistance forclinicians
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- 3. “The emergence andspread of drug- resistant pathogens has accelerated. The trends are clear and ominous. No action today means no cure tomorrow. At a time of multiple calamities in the world, we cannot allow the loss of essential medicines – essential cures for many millions of people – to become the next global crisis.” Dr. Margaret Chan World Health Day 2011 2
- 4. Core competencies for antimicrobialprescribing C1: Understands the patient and the patient’s clinical needs C2: Understands treatment options and how they support the patient’s clinical needs C3: Works in partnership with the patient and other healthcare professionals to develop and implement a treatment plan C4: Communicates the treatment plan and its rationale clearly to the patient and other health professionals C5: Monitors and reviews the patient’s response to treatment 3 Core Competencies
- 5. Objectives • Highlight mechanismsby which microorganisms develop antimicrobial resistance • Illustrate the emergence and global spread of drug resistant organisms • Demonstrate the use of clinical guidelines in choosing empiric antimicrobial therapy – one tool clinicians can use to combat antimicrobial resistance 4
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- 9. Infections due todrug resistant organisms • Longer illnesses • Increased mortality • Prolonged hospitalizations • Increased costs 8
- 10. AMR jeopardizes allpatients - current and future. 9
- 11. Mechanisms of resistance 10 Onecommon multi-drug resistant organism: Neisseria gonorrhoeae U.S. Centers for Disease Control and Prevention – Medical Illustrator
- 12. Inappropriate use ofantimicrobials can have dire consequences. 11
- 13. WHO/A. Kristensen 12 ANTIMICROBIAL RESISTANCE: THEBASICS Core Competencies 1 & 2
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- 15. Selective pressure 14 Population ofbacteriaAntibiotics
- 16. Vertical transmission 15 Time Growing populationof resistant bacteria
- 17. Horizontal transmission 16 Foreign DNAcan be packaged in: • Plasmids • Bacteriophages • Other mobile genetic elements Growing population of resistant bacteria Time
- 18. Major mechanisms ofresistance 17 Target modification Decreased uptake Antibiotic inactivation Increased efflux Core Competencies 1 & 2
- 19. Neisseria gonorrhoeae 18 WHO/S. Nahrgang WHOestimated 78 million new cases of N. gonorrhoeae infections worldwide in people ages 19 – 49 in 2012. Major public health challenge in part because of antimicrobial resistance.
- 20. Gonococcal resistance topenicillin 19 Time Minimuminhibitory concentration(MIC) -penicillin • Resistance to penicillin noted immediately • Over next decades, MIC steadily increased
- 21. Mechanisms of resistance 20 Antibioticinactivation Increased efflux Decreased uptake Target modification WHO/S. Nahrgang
- 22. 21 Target modification Modified targetof beta- lactams: penicillin- binding protein 2 (PBP2) encoded by penA Gonococcal resistance: Primary mechanism of resistance to penicillin WHO/S. Nahrgang
- 23. 22 Decreased uptake Decreased outer membraneporin permeability Increased efflux Overexpression of efflux pumps Gonococcal resistance: Lower intracellular concentrations of penicillin WHO/S. Nahrgang
- 24. Gonococcal resistance: Horizontal transmission 23 Antibioticinactivation Acquired beta-lactamase producing plasmids Beta-lactamases hydrolyze beta-lactam ring WHO/S. Nahrgang
- 25. Resistance to tetracyclines 24 Antibioticinactivation Increased effluxDecreased uptake Target modification U.S. Centers for Disease Control and Prevention – Medical Illustrator
- 26. Increasing gonococcal resistance 25 1943 Penicillin firstused 1986 Tetracyclines not recommended 2007 Fluoroquinolones not recommended Azithromycin not recommended
- 27. 26 PART 2: A CLINICALCASE WHO/A. Kristensen
- 28. 28 year-old malewith: dysuria Urethral discharge sexual partner diagnosed with gonococcal cervicitis no allergies 27
- 29. A clinical case SubsequentevaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessment 28 Core Competencies 1 & 2
- 30. A clinical case SubsequentevaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessment 29 Core Competencies 1 & 2
- 31. Diagnostic workup 30 Depends uponresources • Options: • Gram stain +/- culture • Nucleic acid amplification tests (NAAT) • NAAT can not provide antimicrobial susceptibility data WHO/A. Kristensen Core Competencies 1 & 2
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- 33. Subsequent evaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessmentCeftriaxone250 mg intramuscular OR Cefixime* 400mg oral PLUS Azithromycin 1g oral * CDC no longer recommends Core Competencies 1 & 2
- 34. Subsequent evaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessment Patienteducation critical! • Screen for other sexually treated infections (including HIV) • Screen partners • Safe sex practices • Return to clinic if symptoms persist – consider treatment failure Core Competencies 1 & 2
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- 36. Review: Antimicrobial Resistance Drug Dose Duration Route prescription ............. ............. ............. •Prescribe antimicrobial therapy according to evidence-based guidelines
- 37. Review: Antimicrobial ResistanceReview:Antimicrobial Resistance Drug Dose Duration Route prescription ............. ............. ............. • Prescribe antimicrobial therapy according to evidence-based guidelines • Prevention
- 38. Review: Antimicrobial Resistance Drug Dose Duration Route prescription ............. ............. ............. •Prescribe antimicrobial therapy according to evidence-based guidelines • Prevention • Patient education is critical element of fight against AMR
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- 40. Quiz time! Please click “Next”to proceed.