Antimicrobial resistance II

Question 1

What ar the consequences of AMR? (4)

Answer 1

• Increased mortality
• Increased morbidity
• Costs (length of hospital stay)
• Disease spread

Question 2

Where are the gaps in knowledge about AMR the largest?

Answer 2

Where health systems are weak

Question 3

What should be taken into consideration when you try to create surveillance standards?

Answer 3

-What samples and information to collect
-How to analyze samples
-How to compile and share data

Question 4

Data of which proportion of bacteria should be obtained?

Answer 4

Proportions of resistant bacteria causing specific diseases or affecting defined populations

Question 5

Which connected factors form the ‘One Health Approach”?

Answer 5

• Human disease
• Animal disease
• Environment

Question 6

Why do have to take the animal domain into account when we want to do something about AMR?

Answer 6

Antibiotic use (as growth promoters) in the animal food industry is huge

Question 7

Which elements are present at the interplay between human disease, animal disease and the environment?

Answer 7

• Farming
• Environment
• Sewage water supply
• Nosocomial dissemination
• Contamination between all these factors

Question 8

Criteria used to determine urgency of new antibiotics for pathogens (7)

Answer 8

• All-cause mortality
• Healthcare and community burden
• Prevalence of resistance
• 10-year trend of resistance
• Transmissibility
• Preventability in hospital and community settings
• Treatability and current pipeline

Question 9

What factors contribute to AMR in low-middle-income countries

Answer 9

• Infectious disease burden is high
• Cost constraints
• Absent/rudimentary systematic surveillance systems

Question 10

What does microbiology in developing countries lack? (5)

Answer 10

• Basic equipment
• Technicians
• Automation
• Specialized knowledge
• Quality assurance system

Question 11

Which compound can counteract beta-lactamases?

Answer 11

Beta-lactamase inhibitors

Question 12

What are the three categories of ESBL enzymes?

Answer 12

• SHV
• TEM-1
• CTX-M

Question 13

What phenotypic test can you perform in the lab to determine if a bacterial suspension is ESBL positive/negative?

Answer 13

Double-disc synergy test

Question 14

What are phages thought to do?

Answer 14

Important regulators of the bacterial populations in natural ecosystems

Question 15

True or False: “The abundance of eukaryotic viruses is bigger than that of phages.”

Answer 15

False. The abundance of phages is generally greater than that of eukaryotic viruses

Question 16

Which three categories of bacteriophages are there?

Answer 16

• dsDNA
• ssDNA
• RNA

Question 17

Why are phages suspected to actively contribute to the homeostasis of the bacterial flora of humans?

Answer 17

They can get stuck in our mucosa

Question 18

How does a phage recognize a bug?

Answer 18

• usually species specific - has to do with phage receptors (carbohydrate with helanin on the surface)
• pseudomonas: efflux pumps
• E.coli: different LPS forms

–> insert DNA

Question 19

Transient phage?

Answer 19

Lysogenic vs lytic stage

Question 20

Temperate bacteriophages can induce virulence factors

Question 21

Temperate Bacteriophages can encode genes playing a role in.. (3)

Answer 21

• Colonization/ adhesion
• Resistance to serum/ phagocytes
• Toxins

Question 22

Genetic exchange of bacterial DNA in phages

Answer 22

Formation of transducing phages

Question 23

How are transducing phages formed?

Answer 23

• Prophages can be activated by UV Light
• part of genome ends up in phage

Question 24

What are characteristics of bacteria in their natural habitat? (3)

Answer 24

• Hide underneath our mucosal layers.
• With tract in difficult to access area of the human body
• Form biofilms (clusters of bacteria curved by a matrix of extracellular material)

Question 25

What kind of enzyme is actually designed to kill bacteriophages? Why?

Answer 25

Restriction enzymes. Cuts foreign DNA

Question 26

What are the mechanisms a bacteria can use to become resistant to a phage? (2)

Answer 26

• Prevent attachment
• Kill DNA if it comes in
• Sensing

Question 27

What are the mechanisms that a bacteria can induce after sensing a bacteriophage in itself? (2)

Answer 27

• Inhibition of growth
• Suicide

Question 28

What do you prevent with these bacterial anti-phage measures?

Answer 28

Phage accumulation

Question 29

What is the most common solution to avoid resistance?

Answer 29

Using a phage cocktail

Question 30

How does phage resistance results in antibiotic sensitivity?

Answer 30

• Bacteria changes surface –> doesn’t produce efflux pump
• Safe from phages
• More susceptible to antibiotic exposure, because efflux pumps play a role in fighting off antibiotics

Question 31

Bacteriophages used in phage therapy should .. (6)

Answer 31

• Not disturb the homeostasis of the human bacterial flora
• Not encode toxins
• Not be able to facilitate exchange of bacterial DNA
• Be able to circumvent bacterial defense systems
• Not be neutralized by the hosts humoral response
• Not cause direct/indirect anaphylactic shock

Question 32

What is the added value of phages in opsono-phagocytosis?

Answer 32

Accumulation of antibodies on the surface of the bug