Global Antibiotic Resistance, Causes and Solutions Flashcards
What resistance is emerging in pathogens of global interest?
MRSA - a pandemic
MDR enterobacteriaceae (multi drug resistant)
VRE national issues (vancomycin resistant enterococci)
Acinetobacter baumannii
Clostridium difficile
Why do carbapenem resistant enterobacteriacae differ from other MDR pathogens?
Carbapenem resistant Enterobacteriacae (CRE) differ from other MDR pathogens in that there is no reliable treatment
How do antibiotics increase disease?
With penicilin came staph aureus that was resistant to penicillin
Methicilllin was introduced which led to the birth of MRSA
MRSA outbreak and use of gentamicin
Epidemic strains evolved/spread. Increased use of glycopeptides - vancomycin resistant staph aureus - ‘untreatable MRSA’
How can antibiotics increase the pathogenicity of MRSA?
Bioilm formation
Hypermutation
Toxin production
What factors can increase the chances of MRSA infection?
Poor infection control
MRSA colonisation pressure
MRSA in the environment
Length of stay, medical devices
Antimicrobial consumption
Exposure to fluroquinolones, beta lactams, selection, increased adhesion, increased virulence, patient risk factors
Paradox 5 states •Antibiotics increase infections……………and mortality in uninfected patients?
Evidence suggests that conservative use of antibiotics actually leads to less patient mortality than aggressive use
New systemic antibacterial agents approved by the US Food
and Drug Administration per 5-year period, through 2012. Modified from
Spellberg 2004
This graph shows that the rate of of new and approved drugs being produced is decreasing
What is the projected number of deaths expected to be caused anually by antimicrobial resistance in 2050?
Expected to cause up to 10 million deaths per year
It is currently sitting at around 700000 per year
When prescribing antibiotics, what are the main two things you have to balance?
The best interests of the individual
The global need for sustainable antibiotic use
Conclusions
With current trends in antimicrobial use, new resistances and increasing numbers of infections (new clones) will be generated at home and abroad and spread internationally
Current control efforts are “firefighting”
Prevention requires a new attitude to Antibiotic Stewardship, requiring major decline in antibiotic use and “antibiotic holidays”
What are the antimicrobial paradoxes?
Antibiotics initially led to poorer hygiene
Antibiotics increase infections
Antibiotics can increase the severity of infection
Antibiotics increase infections and mortality in uninfected patients?
Are newer antibiotcs really the answer (can we ever win the ar or would they just feed the cravings of a drug dependant culture)
Antibiotics are too cheap - encourages inappropriate use
Many similarities to global warming
Non-human use is greatest
The global village - resistant bacteria can spread globally
