Antimicrobial resistance

Question 1

Bactericidal

Answer 1

kill bacteria

Question 2

Bacteriostatic

Answer 2

slow/stop bacterial growth

Question 3

Types of resistance

Answer 3

1. Interference with cell wall synthesis
   2.Inhibit protein synthesis
2. Interference with nucleic acid synthesis
3. Disrupt bacterial membrane structure

Question 4

Interference with cell wall synthesis examples

Answer 4

Beta-lactams (penicillin, cephalosporins, carbapenems)

Glycopeptides (vancomycin, teicoplanin)

Question 5

Protein synthesis inhibition examples

Answer 5

50s - Macrolides (azithromycin, clarithromycin, erythromycin), chloramphenicol, clindamycin, linezolid

30s - aminoglycosides (gentamycin, amikacin, neomycin) and tetracycline

Question 6

Interference with nucleic acid synthesis examples

Answer 6

DNA - fluroquinolones (levofloxacin, ciprofloxacin)

RNA - rifampicin

Question 7

Disrupt bacterial membrane structure examples

Answer 7

polymyxin B and E, daptomycin

Question 8

Resistance Mechanisms

Answer 8

1. Mutation - DNA makes organism resistance, preventing antibx binding
2. Enzymes - modify antibx targets
3. Efflux - protein pumps eject antibx from inside cell
4. Immunity - antibx targets bound by proteins that prevent antibx binding to target site

Question 9

Plasmids

Answer 9

DNA circles, move between cells

Question 10

What are Transposons?

Answer 10

small DNA pieces that go into and change DNA

Question 11

What are Phages?

Answer 11

virus’s that attach germs and carry DNA

Question 12

Transduction

Answer 12

DNA / RNA is introduces into bacterial cell by virus / vector

Question 13

Transformation

Answer 13

a bacterium takes up a piece of DNA floating in its environment.

Question 14

Conjugation

Answer 14

DNA is transferred between bacteria through direct contact between cells, tansfer as a plasmid

Question 15

Reasons for prescribing antibiotics

Answer 15

1. prophylaxis
2. empirical therapy
3. direct therapy

Question 16

Causes of resistance

Answer 16

1. laboratory - agar
2. ecological - regional data trends
3. individual patient - review hx

Question 17

MINDME

Answer 17

M – Microbiology guides therapy
I – Indications should be evidence based
N – Narrowest spectrum required
D – Dosage appropriate to the site and type of infection
M – Minimise duration of therapy
E – Ensure monotherapy in most cases

Question 18

Start Smart Then Focus

Answer 18

Secondary Care
1. empirical, broad-spectrum antibx initially (based on clinical judgements, most likely causative bacteria, local guidelines / surgical prophylaxis)
2. Take culture
3. Review 48-72hrs - date on chart
4. Swap to narrow spectrum antibx dependent on lab results
5. STOP/SWAP IV to oral

Question 19

TARGET

Answer 19

Treat Antibiotics Responsibly, Guidance, Education and Tools.

Toolkit designed to support primary care clinicians to achieve and implement antimicrobial stewardship activities

Question 20

ESPAUR

Answer 20

English Surveillance Programme for Antimicrobial Utilisation Rate

Monitor data for changes in antibx resistance

Reduce inappropriate use of antibx

Reduce consumption of antibx in primary care but increase in secondary care

Question 21

Impacts on antimicrobial use

Answer 21

• poor clinical outcomes
• increased ADRs
• increase cost
• delay in administration worsens outcome
• wrong dose worsens outcomes
• excess duration increases resistance, increases healthcare associated infections and increases cost

Question 22

NICE NG15 Antimicrobial Stewardship

Answer 22

• audit
• regular feedback e.g. ADRs, HCAIs
• study resistance
• produce and review guidance
• monitor and evaluate
• education and training

Question 23

NICE Quality Standards (QS121)

Answer 23

S1:
S2:
S3:
S4:
S5:
S6:

Question 24

Top Tips for prescribing antibiotics

Answer 24

1. broad then narrow
2. proper dose
3. shortest duration
4. IV –> oral asap
5. avoid antibx to treat colonisation and contamination