Concerns and Advances

Question 1

Nosocomial Infections

Answer 1

hospital acquired infections. Are highly resistant to antimicrobials and disinfectants

Question 2

Types of antimicrobial resistance

Answer 2

environmentally mediated resistance, microorganism mediated resistance

Question 3

Environmentally mediated resistance

Answer 3

physical and chemical characteristics of the environment that alter the drug or physiologic response of the microorganism. Ex: pH

Question 4

Types of Microorganism Mediated Resistance

Answer 4

Intrinsic Resistance, Acquired Resistance

Question 5

Intrinsic Resistance

Answer 5

preexisting property. Ex: vancomycin resistance in gram negative pathogens, Aztreonam resistance in gram positive cocci

Question 6

Acquired Resistance

Answer 6

resulting from altered cellular microbial physiology and structure due to genetic changes. Unpredictable event that can be acquired by mutation or horizontal gene transfer

Question 7

Mechanisms of Antimicrobial Resistance

Answer 7

1. prevention of penetration to target sites within microbe ex: outer membrane porin mutations
2. Rapid efflux of antibiotics ex: tetracycline resistance
3. enzymatic destruction or inactivation of drug. Ex: beta lactamases, aminoglycoside modifying enzymes
4. Modification or protection of drugs target site. Ex: penicillin binding proteins, ribosome protection (tetracycline), mutations on DNA gyrase gene (fluoroquinolone)

Question 8

Reasons for Emergence of Antimicrobial Resistance

Answer 8

1. widespread antimicrobial use
2. microbial adaptation and change
3. changes in demographics
4. medical advances (implants, catheters, biofilms)
5. changes in ecosystems
6. cutbacks in public health systems

Question 9

Potential Impact of Antimicrobial Resistance

Answer 9

1. increased mortality to infectious diseases
2. veterinarian revisits
3. high treatment costs
4. productivity loss and economic impact
5. zoonotic spread of resistant microbes
6. increased nosocomial infection

Question 10

Examples of problematic bacterial organisms

Answer 10

1. enterococcus, enterobacter, pseuodomonas, acinetobacter: bacteria with high level resistance
2. vancomycin resistant enterococcus
3. methicillin resistant staphylococcus aureus (MRSA)
4. extended spectrum beta lactamase (ESBL) producing E. coli and Klebsiella sp.
5. fluoroquinolone resistant Campylobacter jejuni
6. Multiple drug resistant (MDR) E. coli and Salmonells
7. MDR and XDR mycobacterium tuberculosis

Question 11

Imprudent use of antimicrobials by providers

Answer 11

over prescription for mild and non-bacterial infections. Over selection of broad-spectrum, costly, last-resort drugs

Question 12

Imprudent use of antimicrobials by patients/clients

Answer 12

non-compliance, self-medication/OTC availability

Question 13

Imprudent use of antimicrobials by industry

Answer 13

misleading promotions, competition between brands

Question 14

Strategies to reduce antimicrobial resistance

Answer 14

1. Prudent drug use
2. Pathogen control
3. Policy

Question 15

Antimicrobial Stewardship

Answer 15

the actions taken to preserve the success and availability of antimicrobial drugs through careful oversight and responsible medical decision-making while protecting animal, public, and environmental health.

Question 16

How can you contribute to preventing the emergence of antimicrobial resistance?

Answer 16

By maximizing the efficacy of therapeutic regimen, restricting extra-label use to high risk patients, observing withdrawal protocol, using antimicrobials limited to human health concern, and considering using alternative therapies.