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BACTERIOLOGY - 2 > 32 – Antimicrobial Resistance > Flashcards

32 – Antimicrobial Resistance Flashcards

1
Q

ESKAPE organisms

A
  • E: enterococcus faecium
  • S: staphyloccus aureus (pseudointermedius)
  • K: klebsiella pneumoniae
  • A: acinetobacter baumannii
  • P: pseudomonas aeruginosa
  • E: enterobacter spp.
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2
Q

Canadian antimicrobial resistance surveillance system report

A
  • Many major ones are trending up
  • Decrease in carbapenemases producers during the pandemic
    o Most were travel associated
  • *antimicrobials follow use
    o Pharmacies are prescribing less
  • *room for improvement
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3
Q

Antimicrobial use in dogs and cats

A
  • Cefovecin most common in cats: 32%
  • Amox+clav most comm in dogs: 34%
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4
Q

Stewardship and resistance

A
  • Problem with chickens and humans (ex. Ceftiofur)
    o Voluntary disuse of it=improvement
  • *now banned in poultry industry
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5
Q

How do antibiotics work?

A
  • Attack physiological processes or structures unique to bacteria
    o Cell wall
    o Cell membrane
    o Nucleic acid synthesis, metabolism and organization
    o Protein synthesise
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6
Q

How do bacteria resist antimicrobials?

A
  • Prevent entry
  • Pump out
  • Destroy
  • Disguise
  • Do something else (alternate pathways)
  • Lacking target
  • *deploy intrinsically OR after gaining genetic competence
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7
Q

How do we determine susceptibility?

A
  • Phenotypic susceptibility tests
    o Categorical and quantitative
  • Molecular: resistant NOT susceptible
  • Other phenotypic tests: resistant NOT susceptible
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8
Q

What is antimicrobial resistance? (as a vet)

A
  • Designed to predict clinical outcomes
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9
Q

Intrinsic resistance

A
  • Good graphs of normal allows lab data to be interpreted
  • *independent of antibiotic exposure
  • Ex. Mycoplasma spp. intrinsically resistant to penicillin
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10
Q

SPICE organisms

A
  • S: serratia
  • P: providentia
  • I: indole positive protea
  • C: Citrobacter
  • E: Enterobacter
  • *produce AmpC beta-lactamases
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11
Q

Where does resistance come from?

A
  • *natural phenomenon (PRE-EXISTING)
    o Soil organisms survive in environment that contains antimicrobial compounds
    o Enteric organisms need to survive in presence of bile acids
  • *ANY AND ALL DRUG USE=we are SELECTING for them
    o Inappropriate use=selection pressure with NO benefit
    o *cost-benefit analysis
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12
Q

Evolutionary power of bacteria

A

goes very fast!
o Mutation
o Conjugation
o Transduction
o Transformation

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13
Q

Beta-lactam resistance

A
  1. Altered targets: altered protein binding proteins
  2. Decreased permeability: porin deficiencies
  3. Beta-lactamases
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14
Q

Altered targets examples: beta-lactam resistance

A
  • Methicillin: MRSA/MRSP
  • Penicillin R
  • Intrinsic R
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15
Q

Decreased permeability examples: beta-lactam resistance

A
  • Porin deficiencies
  • *gram-negative rods
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16
Q

Beta lactamases examples: beta-lactam resistance

A
  • Enzymatic degradation VERY common strategy
  • Ex. bacteria!!
17
Q

Why do clinicians need to understand mechanisms of beta-lactam resistance?

A
  • If resistance due to beta-lactamases=can reach for something else
18
Q

What is antimicrobial stewardship?

A
  • Multifaceted and dynamic approaches to sustain the clinical efficacy of antimicrobials
    o Optimizing drug use choice, dosing, duration and route of administration
  • *context-specific and time specific actions!
19
Q

What are some things that influence prescribing decisions?

A
  • Pathogen ID
  • Susceptibility of organism
  • Animal species
  • Signalment
  • Site/type of infection
  • Co-morbidities
  • Route of administration
  • Cost, client compliance, label indication, withdrawal time
20
Q

What are some factors in prescribing decisions? (4)

A
  • Business factors
  • Fear factors
  • Habitual practice factors
  • Pharmaceutical factors
21
Q

Drugs vs. brands

A
  • “the brand is not a drug” -Joe Rubin
  • Recognize impact of marketing
  • Understanding the active ingredient is CRITICAL
22
Q

Proximate risks in antimicrobial use

A
  • *NOT benign interventions!
    o Adverse events do happen (“but what if…”)
  • Ex. 20% given antimicrobials had ADE, 19% with ADE did not need the antimicrobials

BACTERIOLOGY - 2 (15 decks)

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