Antibiotic Resistance/Paradox Flashcards
Paradox 1 - How have antibiotics led to poorer hygiene?
Ignorance
What are the emerging resistance pathogens?
> MRSA - A pandemic
MDR Enterobacteriaceae - Exploding
Carbapenem resistant Enterobacteriaceae (CRE)
VRE - National issues
Acinetobacter baumannii - Challenging
Clostridium difficile - Sleeper awakening
Which form of Enterobacteriaceae does not have a reliable treatment?
Carbapenem resistant Enterobacteriacea (CRE)
Paradox 2 - Antibiotic resistance why?
> Overuse
> Not finishing prescriptions
When was penicillin introduced?
1944
When did S aureus first gain resistance to penicillin?
1950s
When was Methicillin introduced?
1959
When did S aureus first gain resistance to Methicillin?
1961
When was the first true outbreak of MRSA? What antimicrobial was overused as a result?
1963, Increased use of gentamicin
When did epidemic MRSA strains evolve/spread? What antimicrobial was overused as a result?
1970s, Increased use of glycopeptides
When did Vancomycin resistant S aureus emerge? What is the issue with this?
1996 - “Untreatable MRSA”
When did Vancomycin resistant S aureus emerge? What is the issue with this?
1996 - “Untreatable MRSA”
What has happened over the years in terms of the end result of MRSA/MSSA?
An increase in mortality
What is the cause(s) of the increase in prevalence of MRSA?
> Lack of isolation facilities
Poor hygiene, cleaning and disinfection
Antibiotic mis-use
Standard precautions
Bed/staff shortages
Readmission of MRSA carriers from community
What is the relationship of MRSA and antibiotic use?
The higher the consumption of Abx the greater the rates of MRSA
What did Price and Sleigh show in the 1970s regarding MDR K. aerogens outbreaks?
When antibiotic use was reduced so was Klebsiella aerogenes
If someone someone is prescribed cephalosporin for the next 3 month what is the risk of contracting C difficile?
8 times more likely than the rest of the population
If someone someone is prescribed ciprofloxacin for the next 3 month what is the risk of contracting C difficile?
30 times more likely than the rest of the population
Which antibiotic puts an individual at highest risk of C difficile infection?
Ciprofloxacin - 30 times more likely than the rest of the population
When exposed to Quinoles and other antibiotics what leads to an increased pathogenicity of MRSA?
> Biofilm formation > Small colony variants > Efflux > Hypermutation > Skin/RT colonization transmissibility > Fibrinonectin-binding protein >Toxin production eg , TSST-1 > SOS response --> horizontal gene transfer > Phage induction > Quorum sensing > agr expression > Autolysis > Intracellular persistence
When exposed to Quinoles and other antibiotics what leads to an increased pathogenicity of MRSA?
> Biofilm formation > Small colony variants > Efflux > Hypermutation > Skin/RT colonization transmissibility > Fibrinonectin-binding protein >Toxin production eg , TSST-1 > SOS response --> horizontal gene transfer > Phage induction > Quorum sensing > agr expression > Autolysis > Intracellular persistence
What can lead to an increased risk of colonisation?
> Poor infection control > MRSA colonization pressure > MRSA in the environment > Length of stay, medical devices > Antimicrobial consumption
What can lead to an increased risk on infection?
After colonisation:
> Exposure to fluoroquinolones,
ß-lactams - selection, increased adhesion, increased virulence, patient risk factors, etc.
Why may new antibiotics not be the answer to fighting infection?
There is a decreased rate in approvals of new antimicrobials every year
Which strain of MDR A.baumannii was shown to lead to the French epidemic?
AYE has an 86-kb resistance island, with 45 resistance genes.
These are gained through conjugation
Paradox 8 - There are many similarities to Global warming
> Known issue yet little change > Continued and even increased use of antbiotics > Societal need/benefits > Running out > Use impacts benefits > Need for better use > Need for new sources > Need for alternatives > Need for integration > Need for a global plan
Paradox 9 - Non human use is the greatest
> 20-50% antibiotic use in humans is not necessary
> 40-80% antibiotic use in animals questionable value
For which AMR bacteria causing human infections are animals reservoirs for?
> Salmonella > Campylobacter > E. coli > VRE > C difficile > MRSA + S aureus
How can bacteria gain resistance?
Horizontal gene transfer
For which AMR bacteria causing human infections are humans in the community reservoirs for?
> Salmonella > Campylobacter > E. coli > VRE > C. difficile > S. pneumoniae > H. influenzae > MRSA + S aureus
For which AMR bacteria causing human infections are humans in hospitals reservoirs for?
> P. aeuroginosa
A. baumannii
MRSA
Which country has the highest issue with ABx use in animals?
China
Paradox 10 - The Global village
> People travel more
When should Abx be used?
> ICU > Preterm babies > Organ transplants > Cancer chemotherapy > Major surgery
Published estimates - ECDC, Europe, 2009? (Infection, deaths, illness)
> 6 bacterial infections
25K deaths per year
430K illness
Published estimates - CDC, USA, 2013? (Infection, deaths, illness)
> 16 bacterial infections
23K deaths per year
2M illness
Published estimates - O’Neill review, Global, 2013? (Infection, deaths, illness)
> 700k deaths per year
Prediction of deaths caused by AMR? Impact GDP by 2050?
> 10 million deaths/year
> GDP = Cost the world up to 100 trillion USD
How should infection be targeted in the future?
Prevention:
> Antibiotic stewardship
> Decline Abx use
> Antibiotic holidays
