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Year 3 - Infection > Antibiotic Resistance/Paradox > Flashcards

Antibiotic Resistance/Paradox Flashcards

1
Q

Paradox 1 - How have antibiotics led to poorer hygiene?

A

Ignorance

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2
Q

What are the emerging resistance pathogens?

A

> MRSA - A pandemic
MDR Enterobacteriaceae - Exploding
Carbapenem resistant Enterobacteriaceae (CRE)
VRE - National issues
Acinetobacter baumannii - Challenging
Clostridium difficile - Sleeper awakening

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3
Q

Which form of Enterobacteriaceae does not have a reliable treatment?

A

Carbapenem resistant Enterobacteriacea (CRE)

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4
Q

Paradox 2 - Antibiotic resistance why?

A

> Overuse

> Not finishing prescriptions

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5
Q

When was penicillin introduced?

A

1944

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6
Q

When did S aureus first gain resistance to penicillin?

A

1950s

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7
Q

When was Methicillin introduced?

A

1959

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8
Q

When did S aureus first gain resistance to Methicillin?

A

1961

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9
Q

When was the first true outbreak of MRSA? What antimicrobial was overused as a result?

A

1963, Increased use of gentamicin

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10
Q

When did epidemic MRSA strains evolve/spread? What antimicrobial was overused as a result?

A

1970s, Increased use of glycopeptides

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11
Q

When did Vancomycin resistant S aureus emerge? What is the issue with this?

A

1996 - “Untreatable MRSA”

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12
Q

When did Vancomycin resistant S aureus emerge? What is the issue with this?

A

1996 - “Untreatable MRSA”

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13
Q

What has happened over the years in terms of the end result of MRSA/MSSA?

A

An increase in mortality

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14
Q

What is the cause(s) of the increase in prevalence of MRSA?

A

> Lack of isolation facilities
Poor hygiene, cleaning and disinfection
Antibiotic mis-use
Standard precautions
Bed/staff shortages
Readmission of MRSA carriers from community

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15
Q

What is the relationship of MRSA and antibiotic use?

A

The higher the consumption of Abx the greater the rates of MRSA

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16
Q

What did Price and Sleigh show in the 1970s regarding MDR K. aerogens outbreaks?

A

When antibiotic use was reduced so was Klebsiella aerogenes

17
Q

If someone someone is prescribed cephalosporin for the next 3 month what is the risk of contracting C difficile?

A

8 times more likely than the rest of the population

18
Q

If someone someone is prescribed ciprofloxacin for the next 3 month what is the risk of contracting C difficile?

A

30 times more likely than the rest of the population

19
Q

Which antibiotic puts an individual at highest risk of C difficile infection?

A

Ciprofloxacin - 30 times more likely than the rest of the population

20
Q

When exposed to Quinoles and other antibiotics what leads to an increased pathogenicity of MRSA?

A 
> 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
21
Q

When exposed to Quinoles and other antibiotics what leads to an increased pathogenicity of MRSA?

A 
> 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
22
Q

What can lead to an increased risk of colonisation?

A 
> Poor infection control
> MRSA colonization pressure
> MRSA in the environment
> Length of stay, medical devices
> Antimicrobial consumption
23
Q

What can lead to an increased risk on infection?

A

After colonisation:
> Exposure to fluoroquinolones,
ß-lactams - selection, increased adhesion, increased virulence, patient risk factors, etc.

24
Q

Why may new antibiotics not be the answer to fighting infection?

A

There is a decreased rate in approvals of new antimicrobials every year

25
Q

Which strain of MDR A.baumannii was shown to lead to the French epidemic?

A

AYE has an 86-kb resistance island, with 45 resistance genes.

These are gained through conjugation

26
Q

Paradox 8 - There are many similarities to Global warming

A 
> 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
27
Q

Paradox 9 - Non human use is the greatest

A

> 20-50% antibiotic use in humans is not necessary

> 40-80% antibiotic use in animals questionable value

28
Q

For which AMR bacteria causing human infections are animals reservoirs for?

A 
> Salmonella
> Campylobacter
> E. coli
> VRE
> C difficile
> MRSA + S aureus
29
Q

How can bacteria gain resistance?

A

Horizontal gene transfer

30
Q

For which AMR bacteria causing human infections are humans in the community reservoirs for?

A 
> Salmonella 
> Campylobacter
> E. coli 
> VRE
> C. difficile 
> S. pneumoniae
> H. influenzae
> MRSA + S aureus
31
Q

For which AMR bacteria causing human infections are humans in hospitals reservoirs for?

A

> P. aeuroginosa
A. baumannii
MRSA

32
Q

Which country has the highest issue with ABx use in animals?

A

China

33
Q

Paradox 10 - The Global village

A

> People travel more

34
Q

When should Abx be used?

A 
> ICU
> Preterm babies
> Organ transplants
> Cancer chemotherapy 
> Major surgery
35
Q

Published estimates - ECDC, Europe, 2009? (Infection, deaths, illness)

A

> 6 bacterial infections
25K deaths per year
430K illness

36
Q

Published estimates - CDC, USA, 2013? (Infection, deaths, illness)

A

> 16 bacterial infections
23K deaths per year
2M illness

37
Q

Published estimates - O’Neill review, Global, 2013? (Infection, deaths, illness)

A

> 700k deaths per year

38
Q

Prediction of deaths caused by AMR? Impact GDP by 2050?

A

> 10 million deaths/year

> GDP = Cost the world up to 100 trillion USD

39
Q

How should infection be targeted in the future?

A

Prevention:
> Antibiotic stewardship
> Decline Abx use
> Antibiotic holidays

Year 3 - Infection (16 decks)

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