CD 06

Question 1

How does resistance develop?

Answer 1

1. Innately resistant

2. (be acquired) due to a genetic mutation

Question 2

Why bacterial ACQUIRED resistance develop so quickly?

Answer 2

Due to the unique properties of bacterial replication:

Vertical Transmission: Reproduce quickly-Parents to daughter to daughter Known as Vertical transmission

Horizontal Transmission: Extra-chromosomal DNA (plasmids) facilitates the spread of AMR(anti-microbial resistance) called Horizontal transmission, within and between bacterial species (through conjugation, transformation, transduction)

Question 3

What happens with Bacterial Plasmids during AMR?

Answer 3

readily transferred from one bacteria to another bacterial plasmid

Question 4

What is Metabolic burden to a bacteria ?

Answer 4

Plasmid because when plasmid is not present it raplicate faster On the other hand but it lost selective pressure

Question 5

A single plasmid may contain how many resistance genes ?

Answer 5

> 1 resistance genes

Question 6

How bacteria achieve intrinsic (innate) resistance against antibiotics?

Answer 6

1) Drug target is not present
2) Drug can’t cross the OM of a gram
negative cell
3) Or the bacteria may naturally have efflux pumps which remove the drug

Question 7

How bacteria can achieve Acquired Resistance Based on DRUG accumulation mechanism?

Answer 7

Through stopping drug accumulation by following

1) by Decrease entry (influx)
- Reduce the number of pores
- Change the type of pore
- Impair pore function
2) by Increased exit (efflux)
- Genes for efflux pumps can be encoded on plasmids and cause acquired AMR as bacteria gain new efflux pumps
- Mutations can also increase the expression of pumps

Question 8

How bacteria can Acquired Resistance - based on The Target?

Answer 8

Acquired Resistance: 1) the target
• Replace the target – via gene transfer with one that has low affinity for the drug
• Modification of the target – via mutation of the binding site while retaining function
• Protection of the target – dislodge drug or compete with drug for target
• Overproduce the target – via mutation to to retain function

Question 9

How bacteria Acquired Resistance: based on The DRUG?

Answer 9

• Inactivates/breaks down the drug

* Changes/modifies the drug

Question 10

Bacterial Resistance develops can be slower by

Answer 10

Drugs with MULTIPLE mechanisms of action

Question 11

Increasing the concentration of drugs can be effective however Can we just give more drugs???

Answer 11

It depends on drugs mechanisms of action

With some types of resistance increasing the concentration can be effective.

Question 12

What social factors impact on the development of drug resistance?

Answer 12

Misuse/Overuse of antibiotics
• OTC supply of antibiotics
• Incorrect prescribing (viral infections)
• Empirical use of antibiotics
• Prophylactic use (disease hower agyi medicine khawa).
• Increased use of broad spectrum antibiotics
• Use of antibiotics in animal feeds
• Not taking the entire course of antibiotics????????

Question 13

One factor which can develop drug resistance?

Answer 13

Antibiotic use in animal

Question 14

Long course of antibiotics are causing drug resistance ?

Answer 14

Long courses are more associated with resistance (more likely to get missed doses and sub therapeutic levels)

Question 15

Common misconception

Answer 15

Not taking the entire course of antibiotics?

Question 16

m

Answer 16

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Question 17

Antimicrobial stewardship

Answer 17

How fast resistance develops can be regulated by cautious use of antibiotics in appropriate situations

Question 18

Which bacteria is ~ 100% resistance to b-lactams, >50% vancomycin resistant (VRE), gut organism?

Answer 18

Enterococcus faecium (E)

Question 19

Which bacteria is Methicillin resistant (MRSA), now also VRSA, skin organism, commonly infects i.v. lines and other devices?

Answer 19

Staphylococcus aureus (S)

Question 20

Which bacteria cause Hospital infections, and MDR

Answer 20

Enterobacter species (E)

Question 21

Gut organisms,which cause blood infections, and carbapenem resistant (CRKP)

Answer 21

Klebsiella pneumoniae (K) & E.coli

Question 22

Which bacteria is harmful for Aquatic, cystic fibrosis (lung damage)

Answer 22

Pseudomonas aeruginosa (P)

Question 23

Do fungi become multi drug resistant (MDR)?

Answer 23

Yes, but is not such a big problem as with bacteria

Why not?

1. bacterial replication rate is much faster
2. bacteria can transfer resistance on plasmids
3. bacterial replication has more mutations as a result can change in DNA sequence.

Question 24

What is the proportion of high mortality and morbidity by Invasive Candida infections

Answer 24

(~35%), as well as higher health-care costs and prolonged length of hospitalization

Question 25

Does Candida are becoming MDR?

Answer 25

-yes.
With azole, polyenes, and flucytosine
-Little resistance with amphotericin B as well.

Question 26

What we can do to stop or limit AMR?

Answer 26

Modified old drugs
Novel drugs (include herbal), new targets
Improved hygiene
Alternative therapies

Question 27

The proportion of infections of invasive candida?

Answer 27

(35%) as well as High morbidity and mortality. as well as higher health care costs and prolonged length of hospitalization