Drug resistance + pneumonia 10

Question 1

What is the burden of child morbidity and mortality attributable to pneumonia globally?

Answer 1

LRTIs are a leading global cause of mortality in LICs (WHO 2012)
LRTI is low contributor in MIC and HICs - disproportionate contribution in LICs
Respiratory pathogens can cause global pandemics e.g. influenza, SARS, MERS

Question 2

What are the global effects of AMR?

Answer 2

Increased difficulty in control of IDs - reduced effectiveness of Tx
Growth of global trade and travel causes rapid spread to distant countries
Increased healthcare costs
Increased mortality

Question 3

What are the causes of resistance?

Answer 3

Prolonged courses of sub-therapeutic concentraions of Abx and shorter therapeutic periods
Inappropriate use of antimicrobials for RTI’s e.g. viral

Question 4

What are the global initiatives to tackle drug resistance in pneumococcus?

Answer 4

Local/national/international surveillance projects
Campaigns promoting judicious use of antimicrobials (Start smart + focus, UK; Get Smart (US); WHO
R&D for novel therapeutics
Pneumococcal vaccination programmes

Question 5

What are the problems with the plain polysaccharide vaccine?

Answer 5

Not effective in children < 2 years
No effect on nasal carriage
No herd effect
Absence of immunologic memory

Question 6

What are the indirect effects of paediatric pneumococcal vaccination in the population?

Answer 6

60% of preschool children have nasopharyngeal carriage of pneumococcus which infects adults
Herd protection in adults + elderly which decreases morbidity in influenza - vaccinate against influenza and S. pneumococcus

Question 7

What is the benefit of a vaccine?

Answer 7

Decreased disease from vaccination causes decreased antibiotic usage which decreases antibiotic resistance –> decreases pool of antibiotic resistant organism

Question 8

What is the influenza vaccine?

Answer 8

PCV7 vaccine - 7-valent pneumococcal conjugate vaccine
Does not protect against influenza or other viruses but may prevent the secondary pneumococcal infections that have been shown to be more severe than influenza alone

Question 9

What are the effects of healthcare-associated Pneumonia?

Answer 9

Higher risk of multi-drug-resistant pathogens
Patients are more likely than those with standard CAP to receive empirical Abx that don’t cover causative organisms
Infections with MDR organisms is associated with increased mortality, longer hospital stay and higher costs