Week 9 - Topic 1: MDRO - Overview

Question 1

What is AMR

Answer 1

Antimicrobial resistant

Question 2

What does MDR/MDRO stand for

Answer 2

Multi-Drug Resistant Organisms

Question 3

Definition of MDRO

Answer 3

Organism that is resistant to >1 agent in 3+ antimicrobial categories used to treat that bacteria

Question 4

What does XDR stand for

Answer 4

Extensively drug resistant

Question 5

Definition of XDR

Answer 5

More dangerous than MDRO
Bacteria susceptible to only 1-2 antimicrobial categories
Resistant to >1 agent in all but <2 antimicrobial categories

Question 6

What does PDR stand for

Answer 6

Pan Drug Resistant

Question 7

Definition of PDR

Answer 7

Resistant to all agents in antimicrobial categories

We will therefore use experimental or off the market drugs

Question 8

What are the most common antibiotic resistant organisms from the ESKAPE soup?

Answer 8

E nterococcus
S taphylococcus
K lebsiella
A cinetobacter
P seudomonas
E nterobacteriaceae

Question 9

Give 4 examples on how you can get a hospital acquired infection, especially with MDRO

Answer 9

Central line –> bloodstream infection
Use of catheter –> UTI
Surgical site
Ventilator –> pneumonia

Question 10

Describe antibiotic development in the last few decades

Answer 10

Less and less new antibiotics are being produced

Question 11

What is the biggest challenge of modern medicine?

Answer 11

Antibiotic resistance, a ‘silent tsunami’

Causes 700,000 deaths worldwide, and will rise up to 10 million by 2050

Question 12

A bacteria that has antibacterial resistance will be resistant to what?

Answer 12

Antibiotics and other antibacterial drugs

Question 13

A parasite that has antiparasitics resistance will be resistant to what?

Answer 13

Anti-malaria medicines

Question 14

A fungus that has antifungal resistance will be resistant to what?

Answer 14

Medicines used to treat candidiasis

Question 15

A virus that has antiviral resistance will be resistant to what?

Answer 15

Anti-HIV medicines

Question 16

Why does WHO do pathogens prioritization?

Answer 16

To develop new antibiotics for drug-resistant bacterial infections, ESPECIALLY for tuberculosis

Question 17

What is the #1 global infectious disease killer?

Answer 17

Tuberculosis

Question 18

What is the most lethal airborne drug resistant pathogen? Where is it found?

Answer 18

MDR-TB

Eastern Europe, Asia, Africa
in Asia and Africa it can even be XDR-TB

Question 19

Identify 3 of the top countries with the highest reported incidence of MDR-TB to WHO as of 2018

Answer 19

India - China - Russia

Question 20

For which bacteria is it especially hard to find new antibiotics?

Answer 20

Gram - bacteria (they are critical priority!)

Question 21

What are the 3 critical priority bacteria?

Answer 21

Acetinobacter baumannii
Pseudomonas aeruginosa
Enterobactertaceae

All carbapenem-resistant

Question 22

What are the 6 high priority bacteria?

Answer 22

Enterococcus faectum
Helicobacter pylori
Salmonella species
Staphylococcus aureus
Campylobacter species
Neisseria gonorrhoeae

Question 23

What are the three medium priority bacteria?

Answer 23

Streptococcus pneumoniae
Haemophilus influenzae
Shigella species

First 2 cause pneumonia

Question 24

What are the 5 reasons to control AMRs?

Answer 24

1) ↓ colonization of host
2) ↓ toxic Ab options
3) Protect the effectiveness of our limited reserve of antimicrobials
4) ↓ circulating pool of resistance genes
5) 30% of ppl colonized will develop an infection in a few years

Question 25

What are 5 mechanisms of resistance?

Answer 25

1) Acquiring resistance genes via conjugation, transposition or transformation 2) Synthesis of enzymes that break down the drug 3) Chemically ↓ the drug's function 4) Prevent access of the drug to its target by inhibiting uptake, increasing export or modifying the target receptor size 5) Chromosomal mutations during replications

Question 26

Where does antibiotic resistance spread?

Answer 26

Hospitals, nursing homes, daycares, abroad (ex: shigella), water, food, gyms, etc.

Question 27

Give 5 examples of antibiotic classes

Answer 27

1) Penicillin with b-lactam inhibitors 2) 3rd gen cephalosporin 3) Carbapenems 4) Aminoglycosides 5) Fluoroquinolones

Question 28

What are risk factors for AMR colonization

Answer 28

``` Staying in: Prolonged hospital stay ICU Close proximity to infected (sharing same bed/household) Foreign hospital stays LTC facilities ``` ``` Use of: IV Central line Prior antibiotics Ventilators ```

Question 29

Why are patients with comorbidities (especially renal/liver disease and transplant) at risk of AMR colonization?

Answer 29

They are more likely to already be on antibiotics