Antimicrobial resistance

Question 1

What are two carbapenem resistant enterobacteriaciae?

Answer 1

KPC: lebsiella pneumoniae carbapenemase
NDM: new Delhi Metallo-beta-lactamase

Question 2

Whod o carbapenem resistant enterobacteriaeciae usually occur in? (CRE)

Answer 2

primarily in patients who have received extensive medical care

Question 3

What may increase spread of CRE?

Answer 3

medical tourism

Question 4

why is CRE a concern?

Answer 4

usually multiclass resistant, high mortality >40%

Question 5

What are the first line for treatment of sepsis in newborn babies?

Answer 5

carbapenems

Question 6

What are the important principles of antimicrobial resistance?

Answer 6

1. antimicrobials select for resistant populations
2. organisms resistant to one antimicrobial typically become resistant to multiple drugs
3. antimicrobial resistance in one area with eventually appear in other areas
4. once antimicrobial resistance appears, it is unlikely to decline spontaneously

Question 7

What are the main issues of antimicrobial resistance in vet med?

Answer 7

1. preserving antimicrobials for use in human med and protection of human health
2. preservation of antimicrobials for use in vet med and protection of animal health

Question 8

What are 4 things constitute imprudent use of antimicrobials?

Answer 8

1. use when not needed
2. use of wrong drug
3. use of broad spectrum when narrow spectrum would do
4. use of wrong dosage/interval

Question 9

What percent of antimicrobials are used in the community?

Answer 9

80%

Question 10

What % of antimicrobials are used for acute resp tract infections and what % are inappropriate?

Answer 10

75% for ARI

80% inappropriate

Question 11

What are 4 uses of antimicrobials in vet med and food aniaml production?

Answer 11

1. therapy
2. metaphylaxis
3. prophylaxis
4. growth promotion–label being removed

Question 12

What is the international perception of vets with regard to antimicrobials?

Answer 12

1. education lacking
2. large amounts applied with inaccurate dosing etc
3. high % of income in vet

Question 13

What is the vancomycin resistant enterococcus example?

Answer 13

avoparcin was used in Europe in 1990s
VRE in health animals and humans was common while vancomycin has limited use in hospitals in europe and so resistance in hospitals uncommon. in NA, rare VRE resistance in people but higher in hospitals because use vancomycin

Question 14

What is the vancomycin resistant enterococcus example?

Answer 14

avoparcin was used in Europe in 1990s
VRE in health animals and humans was common while vancomycin has limited use in hospitals in europe and so resistance in hospitals uncommon. in NA, rare VRE resistance in people but higher in hospitals because use vancomycin

Question 15

What was Excenel (cefiofur) used for in the poultry industry?

Answer 15

injected into eggs to prevent e. coli infections

Question 16

What pathogen emerged after excenel use in poultry industry? Why can this be an issue?

Answer 16

Salmonella heidelberg was increasinly resistant. It is a frequent infection of people, is invasive so can cuase sepsis and can cause reduced treatment alternatives because use a lot of cephalosporins in preg women and children because cannot use fluoroquinolones

Question 17

What happened after voluntary withdrawal of exenel use in chicks?

Answer 17

reduced S. heidelberg and e. coli ceftiofur resistance