Hospital acquired infection and antibiotic resistance

Question 1

What are 5 main reasons for the high rate of hospital acquired infections?

Answer 1

Very high density of ill people
Lots of people moving around as vectors
Open wounds are easy portals of entry
Inserted medical devices
Antibiotic therapy

Question 2

What are the 5 main mechanisms of actions of antimicrobials and their associated classes?

Answer 2

Inhibition of cell wall synthesis (beta-lactams)
Inhibition of protein synthesis (Chloramphenicol, Aminoglycosides-increased use due to resistance, Macrolides)
Inhibition of nucleic acid replication and transcription (Quinolones)
Injury to plasma membrane (Polymyxin B)
Inhibition of synthesis of essential metabolites (sulfanilamide)

Question 3

What is an antimicrobial?

Answer 3

Any chemical/substance that kills a microbe or stops its growth
Provides a selection pressure for the spread of antimicrobial resistance

Question 4

What are the 4 main mechanisms of antimicrobial resistance?

Answer 4

Altered target site (antibiotic cant bind)
Antibiotic inactivation (new enzyme breaks it down)
Altered metabolism
Decreased drug accumulation

Question 5

Why is antimicrobial resistance associated with high morbidity, mortality, length of hospital stay and cost?

Answer 5

Morbidity, mortality and length of stay - more exposure to hospital pathogens
Cost - more drugs, cost of a bed

Question 6

What are some important multi drug resistance bacterial pathogens?

Answer 6

E.coli
Salmonella
Neisseria gonorrhoeae
MRSA
Streptococcus pneumoniae
Clostridium difficile
Mycobacterium tuberculosis

Question 7

What are the 4 main approaches to prevent hospital acquired infections and development of antibiotic resistance?

Answer 7

Implement strategies e.g. tighter controls, withdraw classes
Reduce use of broad spectrum antibiotics
Identify resistant strains quicker
Combination therapy
Chemically adjust current antibiotics