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Antbiotic resistance

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how the antibiotics develop resistance and what are the measures to be taken to prevent the development of resistance

Publié dans : Santé & Médecine
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Antbiotic resistance

  1. 1. Antimicrobial Resistance Dr Karuna Sree P Asst. Professor Dept. Of Pharmacology KIMS
  2. 2. Contents  History  Antimicrobial resistance  Mechanisms of antibiotic resistance  Strategies to contain resistance  Develop new antibiotics  Judicious use of antibiotics  Indian scenario  Antibiotic policy at KIMS  Summary 3/23/20152 Dr Karuna Sree p, Dept. Of Pharmacology
  3. 3. Evolution of Chemotherapy  A pre- Ehrlich era before 1891  The period of Paul Ehrlich  Magic bullets  The period after 1935 – highlighted by the discovery of sulfonamides & antibiotics 3/23/20153 Dr Karuna Sree p, Dept. Of Pharmacology
  4. 4. In his 1945 Nobel Prize lecture, Fleming himself warned of the danger of resistance – “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body… …and by exposing his microbes to non- lethal quantities of the drug make them resistant.” History Nobel Lecture, December 11, 1945 Sir Alexander Fleming The Nobel Prize in Physiology or Medicine 1945 3/23/20154 Dr Karuna Sree p, Dept. Of Pharmacology
  5. 5. …EVOLUTION OF RESISTANCE TO ANTIBIOTIC 3/23/20155 Dr Karuna Sree p, Dept. Of Pharmacology
  6. 6. Timeline of Antibiotic Resistance 3/23/20156 Dr Karuna Sree p, Dept. Of Pharmacology
  7. 7. ???  antimicrobial resistance  Infections with resistant organisms are associated with increased morbidity and mortality  Extended stays in hospitals  Reduced treatment options - Untreatable infections  Increased healthcare costs  Compromises health security, damage trade & Economy Patients with an antimicrobial-resistant infection may suffer more and pay more for treatment.http://www.cdc.gov/drugresistance/about.html 3/23/20157 Dr Karuna Sree p, Dept. Of Pharmacology
  8. 8. Where antimicrobial resistance is present  It is a serious global challenge.  Every continent and country faces the menace of antibiotic resistant “super bugs.”  Very high rates of resistance observed in common bacteria (for eg., E. coli, K.pneumoniae & Staph.aureus, gonorrhoea) that cause common health-care associated & community- acquired infections 3/23/20158 Dr Karuna Sree p, Dept. Of Pharmacology
  9. 9. 3/23/20159 Dr Karuna Sree p, Dept. Of Pharmacology
  10. 10. 3/23/201510 Dr Karuna Sree p, Dept. Of Pharmacology
  11. 11. Bacterial evolution Vs mankind’s ingenuity 11 • Adult humans contains 1014 cells, only 10% are human – the rest are bacteria • Antibiotic use promotes Darwinian selection of resistant bacterial species • Bacteria have efficient mechanisms of genetic transfer – this spreads resistance • Bacteria double every 20 minutes, humans every 30 years • Development of new antibiotics has3/23/2015Dr Karuna Sree p, Dept. Of Pharmacology
  12. 12. Selection Pressure Bacteria Sensitive to antibiotic Bacteria Resistant to antibiotic After Antibiotic Use 3/23/201512 Dr Karuna Sree p, Dept. Of Pharmacology
  13. 13. Antimicrobial resistance Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections caused by bacteria as well as parasites (e.g. malaria), viruses (e.g. HIV) and fungi (e.g. Candida) http://www.who.int/mediacentre/factsheets/fs194/en/ 3/23/201513 Dr Karuna Sree p, Dept. Of Pharmacology
  14. 14. Other similar terms  Antibiotic tolerance : when the antibiotic no longer kills the microorganisms but merely inhibits its growth / multiplication.  Tolerant microorganisms grow after antibiotic is stopped whereas resistant microorganisms multiply even in the presence of antibiotic. 3/23/201514 Dr Karuna Sree p, Dept. Of Pharmacology
  15. 15. 3/23/201515 Dr Karuna Sree p, Dept. Of Pharmacology
  16. 16. Factors contributing to Antibiotic Resistance Environmental Factors Drug Related Factors Patient Related Factors Prescriber Related Factors Antibiotic Resistance 3/23/201516 Dr Karuna Sree p, Dept. Of Pharmacology
  17. 17. 1. Environmental Factors  Huge populations and overcrowding  Rapid spread – increased travelling  Poor sanitation  Increases community acquired resistance  Ineffective infection control program  Widespread use of antibiotics in animal husbandry and agriculture and as medicated cleansing products 3/23/201517 Dr Karuna Sree p, Dept. Of Pharmacology
  18. 18. Widespread Use of Antimicrobials in Animal Husbandry and Agriculture  The extensive worldwide exploitation of antibiotics in animal care (medicated animal feed) and agriculture (growth promoters) constantly selects for strains of bacteria that are resistant to the drugs. 3/23/201518 Dr Karuna Sree p, Dept. Of Pharmacology
  19. 19. 2. Drug Related  Over the counter availability of antimicrobials  Counterfeit and substandard drug causing sub-optimal blood concentration  Irrational fixed dose combination of antimicrobials  Soaring use of antibiotics Policy Decision at Higher level 3/23/201519 Dr Karuna Sree p, Dept. Of Pharmacology
  20. 20. Soaring Antibiotic Use Antibiotic use (and misuse) has soared since the first commercial versions were introduced and now includes many nonmedicinal applications. 2 >50Million Ton Million Ton 1954 2014 3/23/201520 Dr Karuna Sree p, Dept. Of Pharmacology
  21. 21. 3. Patient Related  Poor adherence of dosage Regimens  Poverty  Lack of sanitation concept  Lack of education  Self-medication  Misconception Patient Counseling, Awareness Program 3/23/201521 Dr Karuna Sree p, Dept. Of Pharmacology
  22. 22. Physician / Prescriber Related  Inappropriate use of available drugs  Increased empiric poly-antimicrobial use  Overuse of antimicrobials  Inadequate dosing  Lack of current knowledge and training 3/23/201522 Dr Karuna Sree p, Dept. Of Pharmacology
  23. 23. DEVELOPMENT OF RESISTANCE: Emerging and Re-emerging Diseases  Emerging and re-emerging diseases are another source for resistance.  Emerging diseases have not been seen before.  Re-emerging are caused by organisms resistant to treatment.  For eg., In India NMEP changed to NVBDCP due to remerging of disease 3/23/201523 Dr Karuna Sree p, Dept. Of Pharmacology
  24. 24. DEVELOPMENT OF RESISTANCE: Emerging and Re-emerging Diseases • 2008 – outbreak of H1N1 virus • 2014 - outbreak of Ebola virus 3/23/201524 Dr Karuna Sree p, Dept. Of Pharmacology
  25. 25. How the bacteria develops resistance ? 3/23/201525 Dr Karuna Sree p, Dept. Of Pharmacology
  26. 26. Antibiotic Resistance Natural Lack of metabolic process / target site Acquired Genetic methods Chromosomal methods - Mutation Extra chromosomal methods – Plasmids Within /between bacteria Biochemical mechanisms By producing enzymes Preventing drug accumulation Modifying target site Use alternative pathways Quorum sensing 3/23/201526 Dr Karuna Sree p, Dept. Of Pharmacology
  27. 27. Antibiotic Resistance Some microorganisms may ‘born’ resistant, some ‘achieve’ resistance by mutation or some have resistance ‘thrust upon them’ by plasmidsSome are born great, some achieve greatness or some have greatness thrust upon them 3/23/201527 Dr Karuna Sree p, Dept. Of Pharmacology
  28. 28. Natural / Intrinsic Resistance It occurs naturally. 1. Lack target : • No cell wall; innately resistant to penicillin 2. Innate efflux pumps: • Drug blocked from entering cell or ↑ export of drug (does not achieve adequate internal concentration). Eg. E. coli, P. aeruginosa 3. Drug inactivation: • Cephalosporinase in Klebsiella 3/23/201528 Dr Karuna Sree p, Dept. Of Pharmacology
  29. 29. Acquired resistance MUTATIONS • It refers to the change in DNA structure of the gene. • Occurs at a frequency of one per million cells. • Even though Mutation rate is low → during course of therapy – sensitive strains die – resistant strains continue to grow & multiply – selection of mutants • Single step / Multistep • Eg.Mycobacterium.tuberculosis,Mycobacterium lepra , MRSA. • Often mutants have reduced susceptibility 3/23/201529 Dr Karuna Sree p, Dept. Of Pharmacology
  30. 30. Plasmids – carriers of DNA • Replicate independently and freely in cytoplasm. • R-plasmids : Those which carry genes resistant (r-genes) to antimicrobials • r-Genes readily transferred from one R-plasmid to another plasmid or to chromosome. • Much of the drug resistance encountered in clinical practice is plasmid mediated 3/23/201530 Dr Karuna Sree p, Dept. Of Pharmacology
  31. 31. Methods of plasmid mediated transfer of antibiotic resistance • Transfer of r-genes from one bacterium to another  Conjugation  Transduction  Transformation • Transfer of r-genes between plasmids within the bacterium  By transposons  By Integrons 3/23/201531 Dr Karuna Sree p, Dept. Of Pharmacology
  32. 32. Transfer of Plasmid : Conjugation  Main mechanism for spread of resistance(single / multidrug)  The conjugative plasmids make a connecting tube (sex pili) between the two bacteria through which plasmid itself can pass.  Commonly observed in bacteria present at high density – as in gut. 3/23/201532 Dr Karuna Sree p, Dept. Of Pharmacology
  33. 33. Bacterial Conjugation 3/23/201533 Dr Karuna Sree p, Dept. Of Pharmacology
  34. 34. Transduction  Less common method  The plasmid DNA enclosed in a bacteriophage (bacterial virus) is transferred to another bacterium of same species.  Seen in Staphylococci , Streptococci 3/23/201534 Dr Karuna Sree p, Dept. Of Pharmacology
  35. 35. Bacterial Transduction 3/23/201535 Dr Karuna Sree p, Dept. Of Pharmacology
  36. 36. Transformation  It poses least clinical problem.  Free DNA is picked up from the environment by the bacteria (from a cell belonging to closely related or same strain).  New DNA is incorporated into the genome & becomes resistant. 3/23/201536 Dr Karuna Sree p, Dept. Of Pharmacology
  37. 37. Bacterial Transformation 3/23/201537 Dr Karuna Sree p, Dept. Of Pharmacology
  38. 38. by Transposons  Transposons are DNA segments that cannot self replicate but can self transfer between palsmids / plasmid to chromosome.  The donor plasmid containing the Transposons, co-integrate with acceptor plasmid & replicate during cointegration.  Both plasmids then separate and each contains the r-gene carrying the transposon.  Eg., Staphylococci, Enterococci 3/23/201538 Dr Karuna Sree p, Dept. Of Pharmacology
  39. 39. Resistance mediated By transposons 3/23/201539 Dr Karuna Sree p, Dept. Of Pharmacology
  40. 40. by Integrons  Integron is a large mobile DNA unit, can spread Multidrug resistance  Packed with multiple gene casettes, consisting of a resistance gene attached to a small recognition site.  They encode several bacterial functions. Eg. resistance & virulence.  They cannot promote self 3/23/201540 Dr Karuna Sree p, Dept. Of Pharmacology
  41. 41. Biochemical mechanisms of antibiotic resistance  Prevention of drug accumulation in the bacterium – altering porin channels / efflux pumps  Modification/protection of the target site  Use of alternative pathways for metabolic / growth requirements  By producing an enzyme that inactivates the antibiotic  Quorum sensing 3/23/201541 Dr Karuna Sree p, Dept. Of Pharmacology
  42. 42. 3/23/201542 Dr Karuna Sree p, Dept. Of Pharmacology
  43. 43. Decreased permeability through Porin channels Example : pencillins 3/23/201543 Dr Karuna Sree p, Dept. Of Pharmacology
  44. 44. Efflux pumps • Cytoplasmic membrane transport proteins. • Major mechanism for resistance in Tetracyclines. • Eg.,  ATP Binding Cassette  Major Facilitator Superfamily (MFS)  Multidrug And Toxic Compound Exporter (MATE)  Staphylococcal Multidrug Resistance Transporters(SMR)  Resistance Nodulation Division Family (RND) 3/23/201544 Dr Karuna Sree p, Dept. Of Pharmacology
  45. 45. Efflux transporters : Drug resistance 3/23/201545 Dr Karuna Sree p, Dept. Of Pharmacology
  46. 46. Modification/Protection of the Target site Target sites Resistant Antibiotics Ribosomal point mutation Tetracyclines, Macrolides, Clindamycin Altered DNA gyrase Fluoroquinolones Modified penicillin binding proteins (S. pneumoniae) Penicillins Mutation in DNA dependant RNA polymerase (M.tuberculosis) Rifampicin 3/23/201546 Dr Karuna Sree p, Dept. Of Pharmacology
  47. 47. Use of alternative pathways for metabolic / growth requirements • Resistance can also occur by alternate pathway that bypasses the reaction inhibited by the antibiotic. • Sulfonamide resistance can occur from overproduction of PABA 3/23/201547 Dr Karuna Sree p, Dept. Of Pharmacology
  48. 48. By producing enzymes that inactivates antibiotic  Inactivation of β-lactam antibiotics • S. aureus, N. gonorrohoea, H.influenza, Produce β-lactamase which cleaves -lactam ring  Inactivation of Chloramphenicol • Inactivated by chloramphenicol acetyltransferase . • Gram-ve (enzyme present constitutively hence higher resistance) gram +ve bacteria (enzyme is inducible )  Inactivation of Aminoglycosides • Inactivated by acetyl, phospho & adenylyl transferases Present in gram +ve and gram –ve . 3/23/201548 Dr Karuna Sree p, Dept. Of Pharmacology
  49. 49. Quorum sensing  Microbes communicate with each other and exchange signaling chemicals (Autoinducers)  These autoinducers allow bacterial population to coordinate gene expression for virulence, conjugation, apoptosis, mobility and resistance. 3/23/201549 Dr Karuna Sree p, Dept. Of Pharmacology
  50. 50. Why named quorum sensing  Single autoinducer from single microbe is incapable of inducing any such change  But when its colony reaches a critical density(quorum), threshold of autoinduction is reached and gene expression starts  QS signal molecules AHL, AIP, AI-2 & AI-3 have been identified in Gm-ve bacteria  AI-2 QS –system is shared by GM+ve bacteria also 3/23/201550 Dr Karuna Sree p, Dept. Of Pharmacology
  51. 51. WHY INHIBIT QUORUM SENSING  Proved to be very potent method for bacterial virulence inhibition.  Several QS inhibitors molecules has been synthesized which include AHL, AIP, and AI-2 analogues  QS inhibitors have been synthesized and have been isolated from several natural extracts such as garlic extract.  QS inhibitors have shown to be potent virulence inhibitor both in in-vitro and in-vivo, using infection animal models. 3/23/201551 Dr Karuna Sree p, Dept. Of Pharmacology
  52. 52. Strategies to control / prevent Resistance Develop new antibiotics Bypass the drug resistance Judicious use of the existing antibiotics: Containment of drug resistance 3/23/201552 Dr Karuna Sree p, Dept. Of Pharmacology
  53. 53. New Antibiotic Development  Only one group of antibiotics in last 35 years  Only 15 antibiotics of 167 under development had a new mechanism of action with the potential to combat of multidrug resistance.  Lack of incentive for companies to develop antibiotics. 3/23/201553 Dr Karuna Sree p, Dept. Of Pharmacology
  54. 54. Hope is not exhausted….yet  Phage therapy  Use of the lytic enzymes found in mucus and saliva  Agents that target type IIA topoisomerases  Antimicrobial peptides (AMPs), lipopeptides (AMLPs)  target bacterial membranes, making it nearly impossible to develop resistance (bacteria would have to totally change their membrane composition). 3/23/201554 Dr Karuna Sree p, Dept. Of Pharmacology
  55. 55. Alternate Approaches Phage therapy • Phage Therapy is the therapeutic use of lytic bacteriophages to treat pathogenic bacteria infections an important alternative to antibiotics • Invade bacterial cells and disrupt bacterial metabolism and cause lysis of bacteria. • The success rate was 80–95% with few gastrointestinal or allergic side effects. British studies also demonstrated significant efficacy of phages against Escherichia coli, Acinetobacter spp., Pseudomonas spp and Staphylococcus aureus. Efflux Pump Inhibitors: verapamil 3/23/201555 Dr Karuna Sree p, Dept. Of Pharmacology
  56. 56. Some newer antibiotics  Ceftobiprole/ceftaroline: V generation cephalosporins  Iclaprim: inhibits Dihydrofolate reductase  Telavancin: inhibition of cell wall synthesis and disruption of membrane barrier function  Dalbavancin: inhibits cell wall synthesis  Tedizolid  Oritavancin  Bedaquiline – multi drug resistant TB - approved  Delamanid – multi drug resistant TB – in trials New approved antibiotics -2014 3/23/201556 Dr Karuna Sree p, Dept. Of Pharmacology
  57. 57. Judicious Use of Antibiotics  Capable of containing antibiotic resistance  Cannot eliminate the possibility of antibiotic development as resistance is an evolutionary process 3/23/201557 Dr Karuna Sree p, Dept. Of Pharmacology
  58. 58. Containment of Resistance  Containment of antibiotic resistance is a multi-pronged program  Involves all stake holders  Physicians  Patients  Pharmaceuticals 3/23/201558 Dr Karuna Sree p, Dept. Of Pharmacology
  59. 59. Patient role in containment  Finish the full course of treatment.  Do not stockpile the leftover doses  Do not medicate yourselves  Do not treat your family and friends 3/23/201559 Dr Karuna Sree p, Dept. Of Pharmacology
  60. 60. Strategy of Containment Antibiotic Resistance Evolutionary Process Faulty Use of Antibiotics Hospital Environmental Empirical Use Definitive Use Community Acquired Antibiotic Resistance Hospital Acquired Antibiotic Resistance Use of antimicrobials before pathogen responsible for a particular illness or the susceptibility to a particular antimicrobial is known 3/23/201560 Dr Karuna Sree p, Dept. Of Pharmacology
  61. 61. Faulty Antibiotic Use  Antimicrobials are over prescribed  Available without prescription - i.e., over the counter drugs 3/23/201561 Dr Karuna Sree p, Dept. Of Pharmacology
  62. 62. Over Prescribed Antibiotics  Clinician should first determine whether antimicrobial therapy is warranted for a given patient 3/23/201562 Dr Karuna Sree p, Dept. Of Pharmacology
  63. 63. Empirical Microbial Selection  Indicated on the basis of clinical findings?  Is it prudent to wait until such clinical findings become apparent?  Can some simple bed side test done to confirm your suspicion?  Microscopy  Gram staining  Have appropriate clinical specimens been obtained to establish a microbial diagnosis?  What are the likely etiological agents 3/23/201563 Dr Karuna Sree p, Dept. Of Pharmacology
  64. 64. Empirical Microbial Selection  What measures should be taken to protect individuals exposed to the index case to prevent secondary cases (1), and what measures should be implemented to prevent further exposure (2)? 12 3/23/201564 Dr Karuna Sree p, Dept. Of Pharmacology
  65. 65. Infection control  Simple measure of hand wash prevents many infections.  Alcohol hand rub to be used between patient contact 3/23/201565 Dr Karuna Sree p, Dept. Of Pharmacology
  66. 66. Empirical Microbial Selection  Is there clinical evidence (e.g. from clinical trials) that antimicrobial therapy will confer clinical benefit for the patient? (Evidence-based medicine) 3/23/201566 Dr Karuna Sree p, Dept. Of Pharmacology
  67. 67. Definitive Treatment • Can a narrower spectrum agent be substituted for initial empiric drug? • Is one agent or combination of agents necessary? 3/23/201567 Dr Karuna Sree p, Dept. Of Pharmacology
  68. 68. Examples  -lactam + Aminoglycosides  Extended spectum Penicillins + -lactamase Inhibitors  Anti-tubercular regimen  Anti-leprotic regimen  Co-trimoxazole  Artemisinin based Combination Therapy (ACT) in Malaria 3/23/201568 Dr Karuna Sree p, Dept. Of Pharmacology
  69. 69. Definitive Treatment What is the  Right dose  Right route of administration  Right duration of therapy? 3/23/201569 Dr Karuna Sree p, Dept. Of Pharmacology
  70. 70. Definitive treatment What specific test to identify patients who will not respond to treatment? 3/23/201570 Dr Karuna Sree p, Dept. Of Pharmacology
  71. 71. Definitive Treatment What adjunctive measures can be undertaken to eradicate infection?  Vaccination  Steroid  Drainage of pus  Amputation  Removal of catheter 3/23/201571 Dr Karuna Sree p, Dept. Of Pharmacology
  72. 72. Who’s Work? Microbiologist Physician Pharmacologist Advise the proper and adequate antibiotics with balancing the economy of 3/23/201572 Dr Karuna Sree p, Dept. Of Pharmacology
  73. 73. Indian scenario  Currently no functioning national antibiotic policy or a national policy  No restriction on Over The Counter (OTC) dispensing of antibiotics  Indian hospitals have varying standards of infection control.  Some hospitals reported very high Gram-negative resistance rates, with very high prevalence of ESBL(Extended Spectrum Beta Lactamases) producers – resistant to imipenems & only sensitive to colistin 3/23/201573 Dr Karuna Sree p, Dept. Of Pharmacology
  74. 74. Indian scenario  A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India – organised in 2012 : lead to evolution of CHENNAI DECLARATION  Stake Holders : Ministry of health, DCGI, state, MCI, NABH, Infection control team(ICT) in all hospitals, ICMR, to standardize the laboratories, National task force for vigilance, to interact with global organizations - WHO and the involvement of medical professionals, societies, NGOs, journals, media, public as well as veterinary practice. 3/23/201574 Dr Karuna Sree p, Dept. Of Pharmacology
  75. 75. Ghafur A, Mathai D, Muruganathan A, Jayalal JA, Kant R, Chaudhary D, et al. "The Chennai Declaration“ Recommendations of "A roadmap- to tackle the challenge of antimicrobial resistance" - A joint meeting of medical societies of India. Indian J Cancer 2012;49:84-94 3/23/201575 Dr Karuna Sree p, Dept. Of Pharmacology
  76. 76. Hospital Acquired Drug Resistance  Hospital infection control committee & Antibiotic policy  Hospital Antibiogram Hospital specific antibacterial Resistance Pattern  Identification of potential pathogen most likely to cause infection  Previous antibacterial therapy  Prescription auditing 3/23/201576 Dr Karuna Sree p, Dept. Of Pharmacology
  77. 77. Hospital infection control committee  Leadership of infection control specialist  Team members  Medical superintendent  General manager  Housekeeping supervisor  Operation theater in-charge  Chief executive officer  Medical director  Representatives of major departments.  Antibiotic steward - for giving second opinion  The committee should meet at least once in three months and discuss important infection control issues  The level of compliance to antibiotic policy  Antibiotic resistance pattern (antibiogram)  The compliance to infection control guidelines 3/23/201577 Dr Karuna Sree p, Dept. Of Pharmacology
  78. 78. Hierarchy of infection control committee 3/23/201578 Dr Karuna Sree p, Dept. Of Pharmacology
  79. 79. Veterinary antibiotic usage Clinical & epidemiological evidence s/o passage of resistant strains from animals to humans  Some countries reported 50% of antimicrobials being used in agriculture / animal husbandry.  In India magnitude is not well studied 3/23/201579 Dr Karuna Sree p, Dept. Of Pharmacology
  80. 80. Methods to curb the spread of resistance from animals to human  Need to evaluate the extent & indications of use.  Need to ascertain and monitor the prevalence of resistant bacteria, like zoonotic food borne bacteria in animals  Need to quantify the rate of transfer of medically-relevant resistance genes & bacteria from animals to humans.  Regular monitoring antibiotic residues in food of animal origin  Formulation/implementation of proper regulations for observance of withholding or withdrawal periods between the use of antibiotics and animal slaughter or milking to avoid residues of antibiotics in milk and meat. 3/23/201580 Dr Karuna Sree p, Dept. Of Pharmacology
  81. 81. Hospital Antibiotic Policy - KIMS  To curb the common misuse and overuse of antibiotics  Restricts the occurrence of antibacterial resistance among the hospital strains  Controls the spread of such infections to susceptible and critically ill patients in the hospital and the subsequent infection into the community.  Saves money for the patient and increases patient satisfaction with decreased side effect 3/23/201581 Dr Karuna Sree p, Dept. Of Pharmacology
  82. 82. Hospital Antibiogram  A periodic summary of antimicrobial susceptibilities of local bacterial isolates submitted to the hospital's clinical microbiology laboratory.  Used by clinicians to assess local susceptibility rates, as an aid in selecting empiric antibiotic therapy, and in monitoring resistance trends over time within an institution 3/23/201582 Dr Karuna Sree p, Dept. Of Pharmacology
  83. 83. Antibiogram of KIMS Hospital Am ox+ CA Gent a Ami ka Nitrof urant oin Norfl ox Cotri moxa zole Cefta zidim e Cefta zidim e+ CA Piper icilin + Tazo Imipe nem E.coli 14.8 52.3 89.6 76.4 15.62 19.3 8.82 60 20 100 Klebsiell a 0 66.66 100 45.4 50 60 9.09 100 0 100 Pseudo monas 0 50 50 Tobra 100 50 0 Netil 100 0 50 100 Acineto bacter 25 50 50 0 25 50 0 0 50 100 Proteus 100 100 100 --- 50 0 0 --- 100 --- Susceptibility pattern of gram negative isolates from urine (% senstivity) 3/23/201583 Dr Karuna Sree p, Dept. Of Pharmacology
  84. 84. Antibiogram of KIMS Hospital  Susceptability pattern of Gram positive isolates (% sensitivity) Organis m Ampi cillin Amo x + CA G Amik a Cipr o Cefo xitin Cotri m Eryth ro Piper cilin+ TZ Vanc omyc in Staph.a ureus 40 40 80 100 40 40 100 40 --- 100 Enteroc occus 0 66.66 66.66 66.66 0 --- --- ---- 66.66 100 Pneumo 66.66 66.66 100 0 33.3 3 --- 0 66.66 ---- 100 Enteroc occus (urine) -- 50 12.5 28.57 15.3 8 --- --- --- 12.5 100 3/23/201584 Dr Karuna Sree p, Dept. Of Pharmacology
  85. 85. Summary  Target definitive therapy to known pathogen  Treat infection, not contamination  Treat infection, not colonization  Know when to say “no” to higher antibiotics  Isolate Pathogen  Break the chain of contagion – Keep your hands clean.  Start simple bed side test: Gram stain, microscopy 3/23/201585 Dr Karuna Sree p, Dept. Of Pharmacology
  86. 86. 3/23/201586 Dr Karuna Sree p, Dept. Of Pharmacology
  87. 87. Thank Q 3/23/201587 Dr Karuna Sree p, Dept. Of Pharmacology

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