5: Antimicrobial resistance and antimicrobial stewardship

Question 1

What percentage of antibiotic prescriptions are unneccessary?

Answer 1

Around 50%

Question 2

What do antimicrobials act on?

Answer 2

All microorganisms

bacteria, fungi, viruses, protozoa

Question 3

What do antibacterials act on?

Answer 3

Bacteria only

Question 4

Antibiotics are mainly (antimicrobials / antibacterials).

Answer 4

antibacterials

Question 5

What are antibiotics?

Answer 5

Produced naturally by microorganisms

Kill/inhibit growth of bacteria (mainly)

Question 6

What is antibiotic resistance?

Answer 6

Ability of a bacteria to protect itself from the effects of an antibiotic

Question 7

What is clinical resistant infection?

Answer 7

Bacteria which can survive in the antibiotic concentrations reached during therapy

Question 8

Is resistance the same as immunity?

Answer 8

No

Bacteria are resistant to varying concentrations of antimicrobials, not totally immune

Question 9

What is the susceptibility of a bacterium to an antibiotic?

Answer 9

Concentration of antibiotic at which it will start to be inhibited / die

Question 10

MDR

PDR

XDR

Define these terms.

Answer 10

MDR - multi-drug resistant (susceptible to 3+ drugs)

XDR - extremely drug resistant (susceptible to 2 or less drugs)

PDR - pandrug resistant (susceptible to nothing)

Question 11

Resistance is either ___ or ___.

Answer 11

innate , acquired

Question 12

How is resistance transferred between bacteria?

Answer 12

Horizontal gene transfer via plasmids

Question 13

Generally, by which two means to bacteria gain resistance?

Answer 13

Vertical transmission (accumulation of mutations through generations)

Horizontal transmission (swapping genes in the same generation)

Question 14

Where are three means of horizontal gene transfer?

Answer 14

Transformation - resistance genes scavenged from dead bacterial cells

Transduction - resistance genes transferred from bacteriophage to bacteria

Conjugation - resistance genes transferred between living bacteria via pilli

Question 15

How do healthy people pick up highly resistant strains of bacteria?

Answer 15

Foreign travel

Question 16

What is an example of an enzyme, produced by resistant bacteria, which inactivates antibiotics?

Answer 16

Beta lactamase

Question 17

Resistant bacterial membranes can be ___ to antibiotics.

Answer 17

impermeable

Question 18

Which antibiotic is usually used to treat Staph. aureus infection?

Answer 18

Flucloxacillin

Question 19

(Under/over)dosing of antibiotics can drive resistance.

Answer 19

Underdosing

Question 20

The use of (narrow / broad) spectrum antibiotics drives resistance.

Answer 20

broad spectrum

e.g cephalosporins, quinolones

Question 21

Antibiotic prescribing is ___ in some countries and this drives resistance.

Answer 21

unregulated

Question 22

How do farmers increase the growth of their stock and prevent them from getting diseases?

Answer 22

Antibiotics in feed

Question 23

The reasoning for prescribing antibiotics should be recorded in a patient’s ___.

Answer 23

notes

Question 24

How long should surgical antibiotic prophylaxis be given for?

Answer 24

A day or so

any longer is excessive

Question 25

What are the four Ds of antimicrobial stewardship?

Answer 25

Choose the right drug

and the right dose

for the right duration

de-escalate if possible