This document discusses the emerging issue of antimicrobial resistance in microorganisms. It provides an overview of antibiotics and multi-drug resistance. Common multi-drug resistant organisms include MRSA, ESBL-producing bacteria, and carbapenem-resistant Enterobacteriaceae. The mechanisms of antibiotic resistance include reduced permeability, enzymatic inactivation, efflux pumps, and target modification. Inappropriate antibiotic usage accelerates the development of resistance. If not addressed, antimicrobial resistance could lead to untreatable infections and increased mortality.

1. Presented by:
Arjun Kumar .K
PG, Dept of Microbiology
ANJA college .

2. OVERVIEW
 Multi drug resistivity of the microorganisms is an
emerging one ,that almost all microbes are being
developed a type of resistance within their cell to
certain groups of drugs.
 These drugs are nothing but the antibiotics that we
use or developing in our immune system
 Due to this resistivity character of microbes there will
be no curation or less curation of the diseases, hence
the pathogen gets adapted to our immune system
 This topic will gives an idea about the drug resistivity
of various microbes with a fine description

3. DRUGS RESEMBLES
ANTIBIOTICS:
 Antibiotics, also called antibacterials, are a type
of antimicrobial drug used in
the treatment and prevention of bacterial
infections. They may either kill or inhibit the
growth of bacteria
 There are different routes of administration for antibiotic
treatment.
 Antibiotics are usually taken by mouth. In more severe
cases, particularly systemic infections, antibiotics can be
given intravenously or by injection.

5. Details of Antibiotics sold during
2005-2009 in India

6. WHAT IS MULTI DRUG RESISTANCE?
Multiple drug resistance (MDR), or drug
resistance or multi resistance is antimicrobial
resistance shown by a species of microorganism to various
antimicrobial drugs.
MDR bacteria that resist multiple antibiotics; other types
include MDR viruses, fungi, and parasites

8. Resistance is accelerated through inappropriate
use of antimicrobials
Standard treatment guidelines is not
provided by physicians or provided
but not adhered to.
Drugs taken without prescription
Inadequate monitoring of diseases
(AMR surveillance programs)
Irrational self-administration or
prescription

9. Resistanceof microbeshas huge
negativeimpacton human health
• Longer duration of illness
• Longer treatment
• Higher mortality
• Increased burden on health system
• Patient acts as reservoir of resistant organisms
which are passed to community and health-
care workers
• Huge economic impact

10. Mechanisms of antibiotic resistance:
Reduced permeability or uptake
Enzymatic inactivation
Enhanced efflux
Alternation or over expression of target
Loss of enzymes involved in drug metabolism
Enzymatic inactivation - β-lactamase(EC No
3.5.2.6) releases the β-lactam ring and inactivates
the β-lactam antibiotics.

11. SOME ANTIBACTERIAL DRUGS:
(BETWEEN 1910 -2010)
 Salvarsan
 Penicillin
 Bacitracin
 Polymyxin
 Isoniazid
 Sulfonamide
 Nitrofurans
 Pleuromutilin
 Metronidazole
 Vancomycin
 Cycloserine
 Novobiocin
 Rifamycin
 Lincomycin
 Fosfomycir
 Mupirocin
 Daptomycin
 Carbapenem
 Oxazolidinone
 Monobactam
 Streptomycin
 Cephalosporin
 Chloramphenicol
 Nalidixic acid

12. COMMON MULTIDRUG-RESISTANT
ORGANISMS (MDROS):
Vancomycin-Resistant Enterococci (VRE)
Methicillin-Resistant Staphylococcus aureus (MRSA)
Extended-spectrum β-lactamase (ESBLs) producing Gram-
negative bacteria
Klebsiella pneumoniae carbapenemase (KPC) producing
Gram-negatives
MultiDrug-Resistant gram negative rods (MDR
GNR) MDRGN bacteria such
as Enterobacter species, E.coli, Klebsiella
pneumoniae, Acinetobacter baumannii, Pseudomonas
aeruginosa

13. GENETIC EXCHANGE OF
ANTIMICROBIAL RESISTANCE GENES
Enterobacteriaceae Enterococci
StaphylococciPseudomonas
Campylobacter
Vibrio cholerae
Pneumococci
Streptococci

14. ESCHERICHIA COLI – RESISTANCE TO
CEPHALOSPORINS
AND TO FLUOROQUINOLONES:
• E. coli is part of the normal flora in the intestine in humans and
animals.
• cephalosporins is mainly conferred by enzymes known as
extended spectrum beta-lactamases (ESBLs); these enzymes
destroy many beta-lactam antibacterial drugs.
• E. coli strains that have ESBL are generally also resistant to several
other antibacterial drugs
• E. coli resistance to fluoroquinolones were similar to those found
for resistance to third-generation cephalosporins.

15. KLEBSIELLA PNEUMONIAE –
RESISTANCE
TO CEPHALOSPORINS
AND TO CARBAPENEMS• Klebsiella are frequent colonizers of the gut in humans and
other vertebrates Causes urinary tract, respiratory tract
infections, bloodstream infections.
• pneumoniae carries a resistance gene (chromosomally located
betalactamase) that have resistance to ampicillin and
amoxicillin
• The presence of extended spectrum
beta lactamase in klebsiella give
resistance to cephalosporins and the
carbapenems

16. STAPHYLOCOCCUS AUREUS –
RESISTANCE
TO METHICILLIN:
• S.aureus is a Gram-positive bacterium that can be a part
of the normal flora on the skin and in the nose and causes
notable infections- skin, soft tissue, bone and bloodstream
infections
• S.aureus gets the resistance by the production of a
betalactamase enzyme that inactivates drugs such as
penicillin, ampicillin and amoxicillin.

17. STREPTOCOCCUS PNEUMONIAE –
RESISTANCE TO
PENICILLIN:
• S. pneumoniae ( also known as pneumococci) is the leading
cause worldwide of community-acquired pneumonia
• It is resistant to penicillin

18. SALMONELLA –
RESISTANCE TO FLUOROQUINOLONES
• Bacteria of the genus Salmonella are a major cause of
foodborne illness throughout the world(zoonotic pathogen)
• These species are resistant to anti microbials like ampicillin,
chloramphenicol,
• streptomycin,
• sulfonamides and
• tetracycline

19. SHIGELLA SPECIES – RESISTANCE TO
FLUOROQUINOLONES
• Shigella species area major cause of diarrhoea
and dysentery
• These bacteria aretransmitted by ingestion of contaminated food orwater
• Formerly, Shigellastrains wereless susceptible to cotrimoxazole, ciprofloxacin and
fluoroquinolones

20. GONORRHOEAE DRUG RESISTANT:
• Neisseria gonorrhoeae – decreased susceptibility to third-
generation cephalosporins

21. MULTIDRUG-RESISTANT
TUBERCULOSIS
• Tuberculosis (TB) is caused by the bacterium Mycobacterium
tuberculosis
• Has slight resistance to rifampicin, isoniazid, ethambutol
and pyrazinamide
• MDR (multi drug resistant) TB is the name given to TB when
the bacteria that are causing it are resistant to at least isoniazid
and rifampicin
• XDR TB (extensively drug resistant TB) resistant to at least
rifampicin and isoniazid,fluoroquinolones,amikacin,
kanamycin, capreomycin.

22. DRUG RESISTANCE
IN MALARIA:
• Malaria is caused by the protozoan parasite
Plasmodium which is transmitted via the bite of
female Anopheles mosquitoes.
• Among the five species of Plasmodium parasites [P.
falciparum, P. vivax, P. ovale,P. malariae and P.
knowlesi] that infect humans are P. falciparum and P.
vivax
• Malaria has slow resistant to chloroquine,
mefloquine or piperaquine
• P. falciparum to amodiaquine and sulfadoxine-
pyrimethamine

23. DRUG RESISTANCE IN
HIV:
• Human immunodeficiency virus (HIV) infects cells of the immune system,
destroying or impairing their function.
• HIV treatments with some drugs are failure
• This have resistance to artesunate-mefloquine,dihydroartemisinin-
piperaquine,
atovaquone-proguanil
• These drugs supress the viral load but don’t kill the virus

24. DRUG RESISTANCE IN
INFLUENZA
VIRUSES
• Influenza imposes a global public health and economic burden for all populations
• Influenza A and B viruses causes acute respiratory illness
• TheA(H1N1) and A(H3N2) subtypes are currently in general circulation in human
populations
• Influenza has a less resistance to adamantanes and neuraminidase

25. CANCER
MULTIDRUG
RESISTANCE
• Canceris a group of diseases involving abnormal cell growth with the potential to
invade or spread to other parts of the body.
• The cancercells actively expel chemotherapy drugs from the interior and thus
resists the drugs
• They have resistance to mechlorethamine,methotrexate, Bendamustine,
Busulfan,Carmustine
Asparagin,Capecitabine etc.

26. ANTIBIOTIC RESISTANT INFECTIONS
Diseases Agent Resistances
Pneumonia S pneumoniae Penicillin
Dysentery S dysenteriae Multiple resistances
Typhoid S typhi Multiple resistances
Gonorrhea N gonorrhoeae Penicillin and
tetracycline
Tuberculosis M tuberculosis Rifampicine and INH
Nosocomial infections S aureus Methicillin, vancomycin
E species Vancomycin
Klebsiella,
Pseudomonas
Multiple resistances

27. ANTIBIOTIC SURVEILLANCE STUDIES
IN VIRUDHUNAGAR DISTRICT
• 100% resistant to penicillin
• 100% of resistance to monobactam group except
Enterococcus
• Pseudomonas sp. showed resistance to both third and
fourth generation cephalosporins at higher rates
• 99.9% of the selected isolates were sensitive to
imipenem during 2013
• 80% of isolates were sensitive to imipenem during 2014

28. LEADING GLOBAL DISEASES
0
1
2
3
4
Respiratory infections HIV Diarrheal diseases Tuberculosis Malaria
Millionsofdeaths,worldwide,1998
S. pneumonia: Up to 55%
resistance to penicillin in some
regions
HIV: Report of
resistance to all
marketed agents
S. dyentariae: 90% resistance to
cotrimoxazole S.Typhi: Outbreaks of
multi-resistant strains in 11 countries
M. tuberculosis:
Multi-drug resistant
tuberculosis
P. falciparum:
Chloroquine resistance in
81/92 countries

29. THE DEATH RATE WILL BE…..

30. Superbugs* are visible manifestations of our prolonged failure to preserve antibiotics
Note: Methicillin resistant Staph aureus, MDR-and XDR Mycobacteria, ESBL producing Gram negative
bacteria and NDM-1 producing
enterobacteriaceae bacteria are few examples of superbugs because these fail to respond to large
number of commonly used antibiotics
Known but neglected.
Need immediate action
Known but
inevitable

31. “Microbes! stop
resistance”