(M) Lec 6.2: Antimicrobial Susceptibility Testing Flashcards
What are the three different antimicrobial agents?
- Antibacterial agents
- Antiviral agents
- Antifungal agents
This antimicrobial agent is destructive to and inhibits bacteria.
Antibacterial agents
This antimicrobial agent weakens and inhibits viruses.
Antiviral agents
This antimicrobial agent inhibits fungi.
Antifungal agents
What are the two categories of antimicrobial agents?
- Bacteriocidal agents
- Bacteriostatic agents
This type of antimicrobial agent kills the microbes (eg. penicillins, cephalosporins, and vancomycin)
Bacterocidal agents
This type of antimicrobial agent inhibits the growth (eg. tetracycline, sulfonamides, erythromycin)
Bacteriostatic agents
Clue: Static, meaning walang growth
T or F: Categories may overlap which depends on the dosage, route of administration, and site of infection.
T
Categories may overlap depending on what three factors?
- Dosage
- Route of administration
- Site of infection
This type of antibiotic has limited spectrum like penicillin G for gram positive organisms.
Narrow-spectrum antibiotics
This type of antibiotic has a wide spectrum against both gram positive and gram negative like tetracycline.
Broad-spectrum antibiotics
Which type of spectrum inhibits and destructs the normal flora of the patient and is a secondary infection or superinfection?
Broad-spectrum antibiotics
What are the things to consider in the selection of the antimicrobial agent?
- Effect to the organism
- Toxicity level to the host and to normal flora
- Pharmacological activities and allergic reactions
- Host’s immune system, medical considerations, and organ functions
- Solubility
- Age of the patient, site of infection, and route of administration
- Toxic to fetus and crosses the placenta or BBB
- Cost effectiveness
What are the four categories/types of antibiotics?
- Cell wall inhibiting
- Altering bacterial cell membranes
- Inhibits protein synthesis
- Inhibits folic acid synthesis
Cell Wall Inhibiting Antibiotics
This type of antibiotic contains the B lactam ring.
Beta lactam antibiotics
Cell Wall Inhibiting Antibiotics
Nucleotide intermediates accumulate in the cell wall = ?
Inhibition of cell wall synthesis
Cell Wall Inhibiting Antibiotics
Penicillin G and V are formed from?
Mold Penicillum notatum
Cell Wall Synthesis Antibiotics
What is the spectrum of synthetic aminopenicillins, ampicillin, amoxicillin, and bacampicillin?
Gram positive other than Staphylococcus (resistant)
Altering Bacterial Cell Membranes Antibiotics
This antibiotic binds to the outer surface of the cell membrane and alter phospholipids.
Bacitracin antibiotics
Altering Bacterial Cell Membranes Antibiotics
Source of bacitracin antibiotics?
Bacillus licheniformis
Altering Bacterial Cell Membranes Antibiotics
What is the spectrum of bacitracin antibiotics?
Gram positive including Staphylococcus and some gram negative
Altering Bacterial Cell Membranes Antibiotics
What is the spectrum of Polymyxins B and E (Colistin)?
Gram negative
Used as topical agents for burns and wound infections
Inhibits Protein Synthesis Antibiotics
These antibiotics interfere with protein synthesis.
- Aminoglycosides
- Erythromycin
- Chloramphenicol
Aminoglycosides: Streptomycin, Tobramycin, and Gentamycin
Inhibits Protein Synthesis Antibiotics
Source of Streptomycin?
Streptomyces griseus
Inhibits Protein Synthesis Antibiotics
What is the spectrum for Streptomycin?
Combination for Tb and B lactam enterococcus
Inhibits Protein Synthesis Antibiotics
Source of Gentamycin?
Micromonospora purpurea
Inhibits Protein Synthesis Antibiotics
What is the spectrum for Gentamycin?
Generally, gram negative bacilli
Inhibits Protein Synthesis Antibiotics
Source of Tobramycin?
Streptomyces fradiae
Inhibits Protein Synthesis Antibiotics
What is the spectrum for Tobramycin?
Recommended in showing resistance to Gentamycin
Inhibits Protein Synthesis Antibiotics
What is the spectrum for Erythromycin?
Gram positive, S. pyogenes, S. pneumoniae (Penicillin-resistant), M. pneumoniae, Legionella, Neisseria, and Haemophilus
Inhibits Protein Synthesis Antibiotics
What is the spectrum for Chloroamphenicol?
Gram positive and gram negative
What are the five types of antibiotics that inhibit folic acid synthesis?
- Sulfonamides
- Quinolones
- Nitrofurantoin
- Rifampin
- Metronidazole
Inhibits Folic Acid Synthesis Antibiotics
Competitive inhibition of folic acid synthesis
Sulfonamides
Inhibits Folic Acid Synthesis Antibiotics (Sulfonamides)
Used primarily for acute UTI
Sulfamethoxazole
Inhibits Folic Acid Synthesis Antibiotics (Sulfonamides)
Inhibits enzyme dihydrofolate reductase
Trimethoprim
Inhibits Folic Acid Synthesis Antibiotics (Sulfonamides)
Treatment of chronic UTI and Enterobacteriaceae infection
Trimethoprim-sulfamethoxazole
Inhibits Folic Acid Synthesis Antibiotics
Inhibition of DNA gyrase activity which interferes with synthesis of DNA
Quinolones
Inhibits Folic Acid Synthesis Antibiotics (Quinolones)
Treats UTI
Nalidixic Acid
Inhibits Folic Acid Synthesis Antibiotics (Quinolones)
Has a broader spectrum and is used as a treatment for UTI and invasive ear infection
Fluoroquinolones (Ciprofloxacin)
Inhibits Folic Acid Synthesis Antibiotics (Quinolones)
Most effective to UTI (excreted and concentrated)
Norfloxacin
Inhibits Folic Acid Synthesis Antibiotics
Inhibition of bacterial enzymes or protein synthesis
Nitrofurantoin
Inhibits Folic Acid Synthesis Antibiotics
Inhibition of DNA-dependent RNA polymerase
Rifampin
Inhibits Folic Acid Synthesis Antibiotics
Used in the treatment of Tb and prophylaxis for N. meningitidis
Rifampin
Inhibits Folic Acid Synthesis Antibiotics
Cause altered DNA synthesis resulting to bacteriocidal effect
Metronidazole
Inhibits Folic Acid Synthesis Antibiotics
Activated under anaerobic conditions and treats Gardnerella vaginosis and pseudomembranous colitis from C. difficile
Metronidazole
Antimycobacterial Agents
Inhibits DNA-dependent RNA polymerase
Rifampin
Antimycobacterial Agents
Inteferes in formation of mycolic acid
Isoniazid (INH)
Antimycobacterial Agents
Bacteriocidal
Pyrazinamide (PZA)
Antimycobacterial Agents
Bacteriostatic and inhibits mycolic acid
Ethambutol
Antimycobacterial Agents
Aminoglycoside that is generally used as a second line drug
Streptomycin
Antifungal Agents
Attacks sterols in fungal cell wall (ergosterols)
Amphotericin B
Antifungal Agents
Prevents sterol synthesis affecting cell membrane
Imidazole
Antifungal Agents
Dermatophytic, yeast, and superficial fungal infection
Clotrimazole
Antifungal Agents
Binds to ergosterol in fungal cell membrane
Nystatin
The preferred laboratory method for susceptibility testing
Kirby-Bauer Disk Diffusion Test
What makes up Kirby-Bauer Disk Diffusion Test?
Standardized suspension + bacteria + MHA + paper disk
Lack of growth = zone of inhibition (diameter is measured)
Clear Zone
Manner of Reporting
Appears to be effective
Susceptible (sensitive)
Manners of Reporting
Appears to be ineffective
Resistant
Manners of Reporting
In between
Intermediate
What is the principle of the laboratory method for susceptibility testing?
Inverse linear relationship between the diameter of the zone of inhibited growth around the antibiotic disk and the algorithm of the minimal inhibitory concentration (MIC) of the organism
T or F: There is a directly proportional linear relationship between the diameter of the zone of inhibited growth around the antibiotic disk and the algorithm of the MIC of the organism.
F
Inverse linear relationship
Lowest concentration of antibiotic that inhibits in vitro bacterial growth
Minimal Inhibitory Concentration (MIC)
- Calcium and Magnesium: activity of aminoglycosides x P. aeruginosa
- Activity of the tetracycline against all bacteria
- Calcium and Magnesium lead to activity against these agents
Mueller Hinton Agar (MHA)
What is the pH for Kirby-Bauer?
7.2 to 7.4
What is the depth for Kirby-Bauer?
4 mm
Density of the inoculum
0.5 McFarland standard
Too light inoculum or older culture
False susceptible
Too heavy inoculum
False resistant
T or F: Night colonies take less than 24 hours.
T
Thicker zone of inhibition leads to?
False resistant
Thinner zone of inhibition leads to?
False susceptible
Incubation for AST?
35 deg. Celsius +/- 2 deg. Celsius for 16 to 18 hours
T or F: Higher temperature leads to larger zone of inhibition.
F
Low temperature
T or F: You can stack more than five plates for AST.
F
You cannot since the center may not reach the correct temperature.
This is needed for fastidious organisms only.
Increased CO2