Antimicrobial Resistance

Question 1

what is under dosing

Answer 1

exposure to non lethal quantities of infection, leads to resistance

Question 2

what general things are antibiotics used for

Answer 2

bacterial pneumonia,
treatment and prophylaxis of surgical site infections,
prevention and treatment of infection following cancer chemotherapy

Question 3

how many people die a year from AMR in the UK

Answer 3

10000

Question 4

what are antimicrobials

Answer 4

agents that act against microorganisms (bacteria, fungi, viruses and protozoa)

Question 5

what are anti bacterial

Answer 5

agents that act only on bacteria (inc antibiotics and disinfectants)

Question 6

what are antibiotics

Answer 6

agents that are produced naturally/synthetically and kill or inhibit the growth of other organism inc bacteria

Question 7

what is antibiotic resistance

Answer 7

the ability of bacteria to protect themselves against the effects of an antibiotic

Question 8

what is clinical resistance

Answer 8

the ability of an bacterium to grow in the antibiotic concentrations reached in the body during therapy

Question 9

what is susceptibility

Answer 9

an antimicrobial will inhibit bacterial growth at clinically achievable concentrations

Question 10

what is MDR

Answer 10

non-susceptibility to at least 1 agent in 3 or more antimicrobial categories

Question 11

what is XDR

Answer 11

non-susceptibility to at least 1 agent in all but 2 or fewer antimicrobial categories (ie, bacterial isolates remain susceptible to only 1 or 2 categories)

Question 12

what is PDR

Answer 12

non-susceptibility to all agents in all antimicrobial categories(ie, no agents tested as susceptible for that organism)

Question 13

what creates AMR

Answer 13

Resistance is either innate or acquired.

can be a natural phenomenon (vertical transmission during replication)
or
mutations in susceptible bacteria create resistant genes which are passed on via conjugation, transposition, or transformation to new bacteria making them resistance (horizontal transmission)

Question 14

what are the resistance mechanisms

Answer 14

inactivation, impermeability, efflux, bypass, Pbps, altered target

Question 15

why are antibiotics used in agriculture

Answer 15

as growth promotors

Question 16

why is resistance increasing

Answer 16

Increasing resistance in community

complacency regarding antibiotics

increased use of empiric broad spectrum antibiotics

antibiotic use in livestock

increasing availability to antibiotics

Question 17

what is antimicrobial stewardship

Answer 17

the optimal selection, dosage, and duration of antimicrobial treatment that results in the best clinical outcome for the treatment or prevention of infection, with minimal toxicity to the patient and minimal impact on subsequent resistance

an organisational or healthcare system wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness

Question 18

what are the 4 D’s of AMS (AM stewardship)

Answer 18

drugs, dosage, duration, de escalation

Question 19

what is poor practise

Answer 19

unnecessary use of broad spectrum, not following guidance, not streamlining or responding to pos microbiology, not considering switching from IV to PO, prolonged duration, underdosing

Question 20

what antibiotics cause C diff infections

Answer 20

quinolones, cephalosporins, broad spectrum;

clindamycin, fluoroquinilones (levofloxacin, ciprofloxacin), pencillins

Question 21

what are the 4 c antiobiotics to avoid prescribing

Answer 21

clindamycin, cephalosporins, co-amoxiclav, ciprofloxacin