Difficult to Treat Bacterial Infections: Have we reached a Dead End?
|
|
- Madeleine Waters
- 5 years ago
- Views:
Transcription
1 Difficult to Treat Bacterial Infections: Have we reached a Dead End? Dr. George M. Varghese MD, DNB, DTMH, FRCP, FIDSA Department of Infectious Diseases Christian Medical College, Vellore, India
2 Outline Bacteria well evolved for survival & lessens learned from history Difficulty in treating due to inability in establishing the diagnosis MDR gram negatives & treatment options Will not discuss: Difficult to eradiate infections eg. biofilm related Immunologically protected sites Immuno-compromised
3
4
5 Bugs versus Drugs (and Humans) The human body has human cells and bacteria! Bacteria are the dominant species on the earth Rapid multiplication rate Natural mutation rate Ability to transfer or move genes via plasmids, transposons etc. Collectively, these properties allow bacteria to survive, change, and eventually flourish under intense selective pressure
6 Search for a Magic bullet Paul Ehrlich ( ) German bacteriologist Father of Chemotherapy Powerful weapon Precise target Selective destruction
7 Discovery of Penicillin Penicillium notatum
8 The Prophecy Dec 11, 1945: There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non lethal quantities of the drug make them resistant
9 Antibiotic Resistance & Evolution PRP VRE VISA MRSA ESBL MBL VRSA β-lactams Penicillin 3rd gen cephalosporin Vancomycin Carbapenem Emergence Spread Vancomycin and teicoplanin Vancomycin and teicoplanin
10 Lechuguilla caves, New Mexico: National Geographic, April 2012
11 Duration of Evolution 3.85 billion years old: bacteria 210 million years old: mammals 60 million years old: human-like mammals 30 million years old: monkeys 0.2 million years old: Neanderthals million years old: Homo sapiens 70 years old: antibiotics
12 Inability to Establish the Diagnosis 49 year-old lady, a renal allograft recipient 7 years ago; on maintenance immunosupp-pred/tac/mmf 3 months history of Fever, headache & vomiting Reported to have recurrent infections for 1 year: initially UTI, then elbow abscess few months ago 2 months ago she was diagnosed to have bacterial meningitis: CSF analysis showed WBC: 1500 (P97, L3) Glucose: 4 mg/dl, protein: 160mg/dl Cultures - negative
13 Evaluation continued Treated with meropenem for 4 weeks Asymptomatic for 2 weeks; recurrence of symptoms again; restarted on meropenem O/E: GCS 14/15; meningeal signs + CSF analysis: WBC: 30 (P24, L71, M5) Glucose: 31mg/dl, protein: 120mg/dl Culture (bacterial, mycobacterial & fungal): no growth; & Xpert: negative MRI brain: small area of chronic haemorrhage in the inferior cerebellar hemisphere Meropenem completed 2weeks and stopped. Started on ATT Worsening of symptoms in 1 week
14 Evaluation continued Repeat CSF analysis: WBC: 690 (P90, L6, M4) Glucose: 19mg/dl, protein: 178mg/dl Culture: no growth
15
16 MDR Gram Negatives ESBL E coli Klebsiella spp. Carbapenem resistance Klebsiella spp. P aeruginosa Acinetobacter baumannii
17 MDR Gram Negatives & Clinical Outcome Limited treatment options Higher mortality rate Longer hospital stay Increased cost
18 Carbapenemases Classification Enzyme Most Common Bacteria Group A Group B (metallo-βlactamse) KPC, SME, IMI, NMC, GES NDM 1 IMP, VIM, GIM, SPM Enterobacteriaceae Enterobacteriaceae P. aeruginosa Acinetobacter spp. Group D OXA Acinetobacter spp. Klbsiella pneumoniae
19 Drugs potentially active against Carbapenamase producers Colistin Tigecycline Fosfomycin Combination therapy
20 Colistin An old drug used in 1950s a.k.a. Polymyxin E, colistimethate sodium Now being used with increasing frequency due to necessity (multidrug resistant Gram-negatives) Risk of neurotoxicity and nephrotoxicity Spectrum of activity Pseudomonas aeruginosa, Acinetobacter spp. E. Coli, Klebsiella, Enterobacter spp. Citrobacter spp, Hemophilus spp. Dose: 9 MIU loading followed by 4.5 MIU Q12H
21 First glycylcycline Tigecycline Structural analogue of minocycline Binds to the 30S subunit of bacterial ribosomes & inhibits protein synthesis Broad spectrum of activity against VRE, MRSA, ESBL+ Enterobacteriaceae, anaerobes No activity against Pseudomonas, Proteus, Providentia Higher dose for critically ill MDR gram neg: 200 mg loading, followed by 100 mg Q12h
22 Colistin + Carbapenems Colistin acts by increasing the permeability of the cell membrane and thus could act synergistically with other antimicrobial agents by facilitating their entrance into the bacterial cell. 1 The mechanism of the observed in vitro synergy is unknown but may relate to high levels of MER entering the bacterial cell via cell membrane disruption by PB 2 1. Kasiakao SK et al. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Aug. 2005, p Pankey GA et al. Diagnos3c Microbiology and Infec3ous Disease 63 (2009)
23 Combination Therapy for MDR-Gram Negatives Reference Regimen N Pathogens Outcome Kontopido etal Clin Micr Inf 2014 Monotherapy (Colistin, aminoglycoside, tigecycline) vs. combinations 127 Klebsiella KPC (ICU) Mortality colistin 23.1%; aminoglycoside 22.7%; tigecycline 31.3%; tigecycline+aminoglycosides, 18.1% ; colistin+aminoglycosides, 11.7% ; colistin+tigecycline, 44.4% Qureshi etal Clin Micr Inf 2012 Monotherapy vs. combinations (colistin or tigecycline + carbapenem) 41 Klebsiella KPC Mortality 57.8% vs. 13.3% Tumberello et CID 2012 Zarkotou etal CMID 2012 Monotherapy vs combinations 125 Klebsiella KPC Mortality 54.3% vs. 34.1% Monotherapy vs. combinations (colistin + tigecycline or tigecycline + gentamicin) 53 Klebsiella KPC Mortality 47 vs 0% Batirel etal EJCMID 2014 Colistin monotherapy (N=36) vs. combination (N=214) 250 XDR A. baumannii Mortality 72 vs. 52% microbiological eradication 56 vs. 80% Daikos etal AAAC 2009 Colistin monotherapy (N=37) vs. combination with carbapenem or aminoglycosides (N=12) 67 Klebsiella MBL Mortality 27 vs. 8.3% D-Mangoni CID 2013 Colistin monotherapy vs. colistin + rifampin 210 XDR A. Baumannii Microbiological eradication 45 vs. 61%
24 New Antibiotics for MDR Gram Negatives Antimicrobial class Compound Carbapenemase activity Indications Aminoglycoside Plazomicin Yes IAIs and UTIs Beta-lactam + betalactamase inhibitor Ceftozolane/tazobactam Ceftazidime/avibactam Ceftaroline/avibactam Aztreonam/avibactam Relebactam/imipenem RPX7009/meropenem No (anti-pseudomonal) Possible(KPC,OXA) Possible (KPC) Yes (NDM1, KPC) Possible (KPC, Amp-C) Yes UTIs, IAIs, HAP, VAP ciais, cutis, HAP and VAP cutis Phase I ciais and cutis cutis Carbapenem Biopenem Doripenem Panipenem Razupenem Tebipenem Tomopenem No No No No No No RTIs, UTIs UTIs, IAIs, HAP, VAP HAP, UTIs SSSI RTIs SSSI and HAP Cephalosporin Ceftobiprole Ceftaroline No No SSTI, HAP, CAP SSSI, CAP Quinolone Delafloxacin Finafloxacin No No SSSI CAP Tetracycline Eravacycline Omadacycline Yes (Acinitobacter) No IAIs and UTIs SSSTI
25 De-escalation Starting with a broad-spectrum empiric therapy regimen (to avoid inappropriate therapy), combined with a commitment to: Change from broad- to narrow-spectrum therapy Reduce duration of therapy Stop therapy in selected patients, as dictated by the patient s clinical response & culture results Culture data are used to narrow, focus or even stop therapy
26 P = Mortality % De-escalated (n=88) No Change (n=245) Escalated (n=61) Kollef MH et al. Chest 2006;129:
27 The Clinician s Dilemma Avoid emergence of multidrug-resistant micro-organisms Immediate treatment of patients with serious sepsis Objective 1 Objective 2
28 Difficult to Treat Bacterial Infections: Have we reached a Dead End?
29 Take-home Messages Number of bacteria in the human body outnumber our own cells Bacteria have well evolved mechanisms to resist adverse conditions Establishing the diagnosis is crucial Important to follow the rational approach in management of gram negative infections Use antibiotics judiciously
30 Thank you
Witchcraft for Gram negatives
Witchcraft for Gram negatives Dr Subramanian S MD DNB MNAMS AB (Medicine, Infect Dis) Infectious Diseases Consultant Global Health City, Chennai www.asksubra.com Drug resistance follows the drug like a
More informationAntibiotic Resistance. Antibiotic Resistance: A Growing Concern. Antibiotic resistance is not new 3/21/2011
Antibiotic Resistance Antibiotic Resistance: A Growing Concern Judy Ptak RN MSN Infection Prevention Practitioner Dartmouth-Hitchcock Medical Center Lebanon, NH Occurs when a microorganism fails to respond
More informationOther Beta - lactam Antibiotics
Other Beta - lactam Antibiotics Assistant Professor Dr. Naza M. Ali Lec 5 8 Nov 2017 Lecture outlines Other beta lactam antibiotics Other inhibitors of cell wall synthesis Other beta-lactam Antibiotics
More informationMechanism of antibiotic resistance
Mechanism of antibiotic resistance Dr.Siriwoot Sookkhee Ph.D (Biopharmaceutics) Department of Microbiology Faculty of Medicine, Chiang Mai University Antibiotic resistance Cross-resistance : resistance
More informationAppropriate antimicrobial therapy in HAP: What does this mean?
Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,
More informationFighting MDR Pathogens in the ICU
Fighting MDR Pathogens in the ICU Dr. Murat Akova Hacettepe University School of Medicine, Department of Infectious Diseases, Ankara, Turkey 1 50.000 deaths each year in US and Europe due to antimicrobial
More informationWhat s next in the antibiotic pipeline?
What s next in the antibiotic pipeline? Jennifer Tieu, Pharm.D., BCPS Clinical Pearls OSHP Spring Meeting Mercy Hospital April 13, 2018 Objective 2 Describe the drug class and mechanism of action of antibiotics
More informationUpdates on the Management of Hospital Acquired Infections and Resistant Organisms
Updates on the Management of Hospital Acquired Infections and Resistant Organisms Conflict of Interest I, Kaitlin McGinn, have no actual or potential conflict of interest in relation to this program. Kaitlin
More informationUpdates on the Management of Hospital Acquired Infections and Resistant Organisms
Updates on the Management of Hospital Acquired Infections and Resistant Organisms Kaitlin McGinn, PharmD Assistant Clinical Professor, Critical Care Auburn University, Harrison School of Pharmacy November
More informationAntibiotics. Antimicrobial Drugs. Alexander Fleming 10/18/2017
Antibiotics Antimicrobial Drugs Chapter 20 BIO 220 Antibiotics are compounds produced by fungi or bacteria that inhibit or kill competing microbial species Antimicrobial drugs must display selective toxicity,
More informationOutline. Antimicrobial resistance. Antimicrobial resistance in gram negative bacilli. % susceptibility 7/11/2010
Multi-Drug Resistant Organisms Is Combination Therapy the Way to Go? Sutthiporn Pattharachayakul, PharmD Prince of Songkhla University, Thailand Outline Prevalence of anti-microbial resistance in Acinetobacter
More informationBurton's Microbiology for the Health Sciences. Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents
Burton's Microbiology for the Health Sciences Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents Chapter 9 Outline Introduction Characteristics of an Ideal Antimicrobial Agent How
More informationMono- versus Bitherapy for Management of HAP/VAP in the ICU
Mono- versus Bitherapy for Management of HAP/VAP in the ICU Jean Chastre, www.reamedpitie.com Conflicts of interest: Consulting or Lecture fees: Nektar-Bayer, Pfizer, Brahms, Sanofi- Aventis, Janssen-Cilag,
More informationThe β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018
The β- Lactam Antibiotics Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Penicillins. Cephalosporins. Carbapenems. Monobactams. The β- Lactam Antibiotics 2 3 How
More informationAntimicrobial Therapy
Antimicrobial Therapy David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle Disclosure: Dr. Spach has no significant financial interest in any of the
More informationSelective toxicity. Antimicrobial Drugs. Alexander Fleming 10/17/2016
Selective toxicity Antimicrobial Drugs Chapter 20 BIO 220 Drugs must work inside the host and harm the infective pathogens, but not the host Antibiotics are compounds produced by fungi or bacteria that
More informationInfectious Disease: Drug Resistance Pattern in New Mexico
Infectious Disease: Drug Resistance Pattern in New Mexico Are these the world's sexiest accents? Obi C. Okoli, MD.,MPH. Clinic for Infectious Diseases Las Cruces, NM. Are these the world's sexiest accents?
More informationIntrinsic, implied and default resistance
Appendix A Intrinsic, implied and default resistance Magiorakos et al. [1] and CLSI [2] are our primary sources of information on intrinsic resistance. Sanford et al. [3] and Gilbert et al. [4] have been
More informationAntimicrobial Cycling. Donald E Low University of Toronto
Antimicrobial Cycling Donald E Low University of Toronto Bad Bugs, No Drugs 1 The Antimicrobial Availability Task Force of the IDSA 1 identified as particularly problematic pathogens A. baumannii and
More informationMICRONAUT MICRONAUT-S Detection of Resistance Mechanisms. Innovation with Integrity BMD MIC
MICRONAUT Detection of Resistance Mechanisms Innovation with Integrity BMD MIC Automated and Customized Susceptibility Testing For detection of resistance mechanisms and specific resistances of clinical
More informationScottish Medicines Consortium
Scottish Medicines Consortium tigecycline 50mg vial of powder for intravenous infusion (Tygacil ) (277/06) Wyeth 9 June 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the
More informationMulti-drug resistant microorganisms
Multi-drug resistant microorganisms Arzu TOPELI Director of MICU Hacettepe University Faculty of Medicine, Ankara-Turkey Council Member of WFSICCM Deaths in the US declined by 220 per 100,000 with the
More informationA snapshot of polymyxin use around the world South America
A snapshot of polymyxin use around the world South America Alexandre P. Zavascki Infectious Diseases Service, Hospital de Clínicas de Porto Alegre Medical School, Federal University of Rio Grande do Sul
More informationMultidrug-Resistant Organisms: How Do We Define them? How do We Stop Them?
Multidrug-Resistant Organisms: How Do We Define them? How do We Stop Them? Roberta B. Carey, PhD Centers for Disease Control and Prevention Division of Healthcare Quality Promotion Why worry? MDROs Clinical
More informationIntroduction to Chemotherapeutic Agents. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The university of Jordan November 2018
Introduction to Chemotherapeutic Agents Munir Gharaibeh MD, PhD, MHPE School of Medicine, The university of Jordan November 2018 Antimicrobial Agents Substances that kill bacteria without harming the host.
More informationRise of Resistance: From MRSA to CRE
Rise of Resistance: From MRSA to CRE Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine SUPERBUGS (AKA MDROs) MRSA Methicillin-resistant S. aureus Evolution of Drug Resistance
More informationAntibiotic. Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting
Antibiotic Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting Any substance of natural, synthetic or semisynthetic origin which at low concentrations kills or inhibits the growth of bacteria
More informationBreaking the Ring. β-lactamases and the Great Arms Race. Bryce M Kayhart, PharmD, BCPS PGY2 Pharmacotherapy Resident Mayo Clinic - Rochester
Breaking the Ring β-lactamases and the Great Arms Race Bryce M Kayhart, PharmD, BCPS PGY2 Pharmacotherapy Resident Mayo Clinic - Rochester 2015 MFMER slide-1 Disclosures I have no relevant financial relationships
More informationLEARNING OBJECTIVES ANTIMICROBIAL USES AND ABUSES INFECTIOUS DISEASE SCARES
LEARNING OBJECTIVES ANTIMICROBIAL USES AND ABUSES Goodbye to the Antibiotic Era? Glenn D. Bedsole, MD, FACP Infectious Disease Consultant 1. Be able to list 6 examples of resistant bacteria that present
More information5/4/2018. Multidrug Resistant Organisms (MDROs) Objectives. Outline. Define a multi-drug resistant organism (MDRO)
Multidrug Resistant Organisms (MDROs) Kasturi Shrestha, M.D. 05/11/2018 Objectives Define a multi-drug resistant organism (MDRO) Identify most challenging MDROs in healthcare Identify reasons for health
More informationChemotherapy of bacterial infections. Part II. Mechanisms of Resistance. evolution of antimicrobial resistance
Chemotherapy of bacterial infections. Part II. Mechanisms of Resistance evolution of antimicrobial resistance Mechanism of bacterial genetic variability Point mutations may occur in a nucleotide base pair,
More informationOther β-lactamase Inhibitor (BLI) Combinations: Focus on VNRX-5133, WCK 5222 and ETX2514SUL
Other β-lactamase Inhibitor (BLI) Combinations: Focus on VNRX-5133, WCK 5222 and ETX2514SUL David P. Nicolau, PharmD, FCCP, FIDSA Director, Center for Anti-Infective Research and Development Hartford Hospital
More informationSafe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times
Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University
More informationLearning Points. Raymond Blum, M.D. Antimicrobial resistance among gram-negative pathogens is increasing
Raymond Blum, M.D. Learning Points Antimicrobial resistance among gram-negative pathogens is increasing Infection with antimicrobial-resistant pathogens is associated with increased mortality, length of
More information2012 ANTIBIOGRAM. Central Zone Former DTHR Sites. Department of Pathology and Laboratory Medicine
2012 ANTIBIOGRAM Central Zone Former DTHR Sites Department of Pathology and Laboratory Medicine Medically Relevant Pathogens Based on Gram Morphology Gram-negative Bacilli Lactose Fermenters Non-lactose
More informationFlorida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC
Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC 11/20/2014 1 To describe carbapenem-resistant Enterobacteriaceae. To identify laboratory detection standards for carbapenem-resistant
More informationDr. Shaiful Azam Sazzad. MD Student (Thesis Part) Critical Care Medicine Dhaka Medical College
Dr. Shaiful Azam Sazzad MD Student (Thesis Part) Critical Care Medicine Dhaka Medical College INTRODUCTION ICU acquired infection account for substantial morbidity, mortality and expense. Infection and
More informationAntimicrobial Resistance and Prescribing
Antimicrobial Resistance and Prescribing John Ferguson, Microbiology & Infectious Diseases, John Hunter Hospital, University of Newcastle, NSW, Australia M Med Part 1 updates UPNG 2017 Tw @mdjkf http://idmic.net
More informationInfectious Disease Issues in the Intensive Care Unit
Infectious Disease Issues in the Intensive Care Unit Catherine Liu, M.D. Assistant Clinical Professor Division of Infectious Diseases University of California, San Francisco Overview Emerging antibiotic
More informationPrevalence of Metallo-Beta-Lactamase Producing Pseudomonas aeruginosa and its antibiogram in a tertiary care centre
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 4 Number 9 (2015) pp. 952-956 http://www.ijcmas.com Original Research Article Prevalence of Metallo-Beta-Lactamase
More informationAntibiotics and Stewardship: What s New in Pediatrics-Land?
Antibiotics and Stewardship: What s New in Pediatrics-Land? Sean P. Elliott, MD Professor of Pediatrics Associate Chair of Education, Department of Pediatrics University of Arizona College of Medicine
More informationTrea%ng Sepsis in 2016 Are the Big Guns Losing the War?
Trea%ng Sepsis in 2016 Are the Big Guns Losing the War? ERIC HODGSON FCA (Crit Care) Inkosi Albert Luthuli Central Hospital & NELSON R MANDELA SCHOOL OF MEDICINE DURBAN, KZN Declaration Advisory boards
More informationAntimicrobial stewardship: Quick, don t just do something! Stand there!
Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger
More informationUpdate on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia. Po-Ren Hsueh. National Taiwan University Hospital
Update on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia Po-Ren Hsueh National Taiwan University Hospital Ventilator-associated Pneumonia Microbiological Report Sputum from a
More informationAntimicrobials & Resistance
Antimicrobials & Resistance History 1908, Paul Ehrlich - Arsenic compound Arsphenamine 1929, Alexander Fleming - Discovery of Penicillin 1935, Gerhard Domag - Discovery of the red dye Prontosil (sulfonamide)
More informationGORILLACILLINS IN THE ICU:
Conflicts of Interest None to declare GORILLACILLINS IN THE ICU: From SPACE and Beyond... Tim T.Y. Lau, PharmD, FCSHP Clinical Pharmacy Specialist in Infectious Diseases Pharmaceutical Sciences, Vancouver
More informationAntimicrobials. Antimicrobials
Antimicrobials For more than 50 years, antibiotics have come to the rescue by routinely producing rapid and long-lasting miracle cures. However, from the beginning antibiotics have selected for resistance
More informationAntimicrobials Update
Antimicrobials Update Rosie Amini, PharmD. BCPS Antimicrobial Stewardship Program Coordinator Swedish Medical Center Disclosures: Dr. Amini has no significant financial interest in any of the products
More informationBad Bugs. Pharmacist Learning Objectives. Antimicrobial Resistance. Patient Case. Pharmacy Technician Learning Objectives 4/8/2016
Pharmacist Learning Objectives Antimicrobial Resistance Julie Giddens Pharm D, BCPS Infectious Disease Clinical Pharmacist OSF Saint Francis Medical Center Peoria, IL The speaker has no conflicts to disclose
More informationCARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE)
CARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE) Bartsch SM et al. Potential economic burden of carbapenem-resistent Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect 2017;23(1):48e9-e16.
More informationPRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE
PRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE Global Alliance for Infection in Surgery World Society of Emergency Surgery (WSES) and not only!! Aims - 1 Rationalize the risk of antibiotics overuse
More informationResistant Gram-negative Bacteria
Introduction Antibiotic-resistant bacteria aren t new. But gram-negative bacteria, like Enterobacteriaceae, are becoming more resistant to our last-line antibiotics. Some people are calling these bacteria
More informationConsequences of Antimicrobial Resistant Bacteria. Antimicrobial Resistance. Molecular Genetics of Antimicrobial Resistance. Topics to be Covered
Antimicrobial Resistance Consequences of Antimicrobial Resistant Bacteria Change in the approach to the administration of empiric antimicrobial therapy Increased number of hospitalizations Increased length
More informationMID 23. Antimicrobial Resistance. Consequences of Antimicrobial Resistant Bacteria. Molecular Genetics of Antimicrobial Resistance
Antimicrobial Resistance Molecular Genetics of Antimicrobial Resistance Micro evolutionary change - point mutations Beta-lactamase mutation extends spectrum of the enzyme rpob gene (RNA polymerase) mutation
More informationMicrobiology ( Bacteriology) sheet # 7
Microbiology ( Bacteriology) sheet # 7 Revision of last lecture : Each type of antimicrobial drug normally targets a specific structure or component of the bacterial cell eg:( cell wall, cell membrane,
More informationAntimicrobial Resistance
Antimicrobial Resistance Consequences of Antimicrobial Resistant Bacteria Change in the approach to the administration of empiric antimicrobial therapy Increased number of hospitalizations Increased length
More informationAntimicrobial Resistance Acquisition of Foreign DNA
Antimicrobial Resistance Acquisition of Foreign DNA Levy, Scientific American Horizontal gene transfer is common, even between Gram positive and negative bacteria Plasmid - transfer of single or multiple
More informationPresenter: Ombeva Malande. Red Cross Children's Hospital Paed ID /University of Cape Town Friday 6 November 2015: Session:- Paediatric ID Update
Emergence of invasive Carbapenem Resistant Enterobacteriaceae CRE infection at RCWMCH Ombeva Oliver Malande, Annerie du Plessis, Colleen Bamford, Brian Eley Presenter: Ombeva Malande Red Cross Children's
More information4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES
CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA BILLIE BARTEL, PHARMD, BCCCP APRIL 7 TH, 2017 DISCLOSURE I have had no financial relationship over the past 12 months with any commercial
More informationETX0282, a Novel Oral Agent Against Multidrug-Resistant Enterobacteriaceae
ETX0282, a Novel Oral Agent Against Multidrug-Resistant Enterobacteriaceae Thomas Durand-Réville 02 June 2017 - ASM Microbe 2017 (Session #113) Disclosures Thomas Durand-Réville: Full-time Employee; Self;
More informationAntimicrobial agents. are chemicals active against microorganisms
Antimicrobial agents are chemicals active against microorganisms Antibacterial Agents Are chemicals active against bacteria Antimicrobials Antibacterial Antifungal Antiviral Antiparasitic: -anti protozoan
More informationThe impact of antimicrobial resistance on enteric infections in Vietnam Dr Stephen Baker
The impact of antimicrobial resistance on enteric infections in Vietnam Dr Stephen Baker sbaker@oucru.org Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Outline The impact of antimicrobial
More informationThe Rise of Antibiotic Resistance: Is It Too Late?
The Rise of Antibiotic Resistance: Is It Too Late? Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine None DISCLOSURES THE PROBLEM Antibiotic resistance is one of the
More informationHospital ID: 831. Bourguiba Hospital. Tertiary hospital
Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in hospitals worldwide Hospital ID: 831 Habib Bourguiba Hospital Tertiary hospital Tunisia Point Prevalence Survey Habib 2017
More informationInt.J.Curr.Microbiol.App.Sci (2017) 6(3):
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 3 (2017) pp. 891-895 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.603.104
More informationGENERAL NOTES: 2016 site of infection type of organism location of the patient
GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered
More informationNew Drugs for Bad Bugs- Statewide Antibiogram
New Drugs for Bad Bugs- Statewide Antibiogram Felicia Matthews, Pharm.D., BCPS Senior Consultant, Pharmacy Specialty BE MedMined Services Disclosures Employee of BD Corporation MedMined Services Agenda
More information2015 Antibiogram. Red Deer Regional Hospital. Central Zone. Alberta Health Services
2015 Antibiogram Red Deer Regional Hospital Central Zone Alberta Health Services Introduction. This antibiogram is a cumulative report of the antimicrobial susceptibility rates of common microbial pathogens
More information1/30/ Division of Disease Control and Health Protection. Division of Disease Control and Health Protection
Surveillance, Outbreaks, and Reportable Diseases, Oh My! Assisted Living Facility, Nursing Home and Surveyor Infection Prevention Training February 2015 A.C. Burke, MA, CIC Health Care-Associated Infection
More informationProtein Synthesis Inhibitors
Protein Synthesis Inhibitors Assistant Professor Dr. Naza M. Ali 11 Nov 2018 Lec 7 Aminoglycosides Are structurally related two amino sugars attached by glycosidic linkages. They are bactericidal Inhibitors
More informationWhat does multiresistance actually mean? Yohei Doi, MD, PhD University of Pittsburgh
What does multiresistance actually mean? Yohei Doi, MD, PhD University of Pittsburgh Disclosures Merck Research grant Clinical context of multiresistance Resistance to more classes of agents Less options
More informationCombating Drug-Resistant Infections Globally. Company Presentation
Combating Drug-Resistant Infections Globally Company Presentation Forward-Looking Statements and Other Important Cautions Any statement in this presentation about our future expectations, plans and prospects,
More informationMicrobiology. Multi-Drug-Resistant bacteria / MDR: laboratory diagnostics and prevention. Antimicrobial resistance / MDR:
Microbiology Multi-Drug-Resistant bacteria / MDR: laboratory diagnostics and prevention June 2017 MeshHp (VS) Medical Care Center Dr. Eberhard & Partner Dortmund (ÜBAG) www.labmed.de MVZ Dr. Eberhard &
More informationSuccessful stewardship in hospital settings
Successful stewardship in hospital settings Pr Charles-Edouard Luyt Service de Réanimation Institut de Cardiologie Groupe Hospitalier Pitié-Salpêtrière Université Pierre et Marie Curie, Paris 6 www.reamedpitie.com
More informationCombating Drug-Resistant Infections Globally. Company Presentation
Combating Drug-Resistant Infections Globally Company Presentation Forward-Looking Statements and Other Important Cautions Any statement in this presentation about our future expectations, plans and prospects,
More information9/30/2016. Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS
Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS 1 2 Untoward Effects of Antibiotics Antibiotic resistance Adverse drug events (ADEs) Hypersensitivity/allergy Drug side effects
More informationGlobal Antibiotic Research and Development (GARD) Partnership Pasteur Institute DNDi Meeting February 29, 2016
Global Antibiotic Research and Development (GARD) Partnership Pasteur Institute DNDi Meeting February 29, 2016 Professor Visanu Thamlikitkul, MD Faculty of Medicine Siriraj Hospital, Mahidol University
More informationDr Kamini Walia Indian Council of Medical Research
Dr Kamini Walia Indian Council of Medical Research The apex body in India for the formulation, coordination and promotion of biomedical research under Department of Health Research, Ministry of Health
More informationChallenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems
Micro 301 Antimicrobial Drugs 11/7/12 Significance of antimicrobial drugs Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Definitions Antibiotic Selective
More informationNew Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs
New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs Patrick R. Murray, PhD Senior Director, WW Scientific Affairs 2017 BD. BD, the BD Logo and all other trademarks
More informationAntimicrobial Resistance
Antimicrobial Resistance Consequences of Antimicrobial Resistant Bacteria Change in the approach to the administration of Change in the approach to the administration of empiric antimicrobial therapy Increased
More informationAntimicrobial Susceptibility Testing: Advanced Course
Antimicrobial Susceptibility Testing: Advanced Course Cascade Reporting Cascade Reporting I. Selecting Antimicrobial Agents for Testing and Reporting Selection of the most appropriate antimicrobials to
More informationNon-Susceptibility of Bacterial Pathogens Causing Hospital-Onset Pneumonia UK and Ireland,
Non-Susceptibility of Bacterial Pathogens Causing Hospital-Onset Pneumonia UK and Ireland, 2008-2016 Alicia Russell Federation of Infection Societies conference 14 th November 2018 alisia_russell BSAC
More informationANTIBIOTIC RESISTANCE. Syed Ziaur Rahman, MD, PhD D/O Pharmacology, JNMC, AMU, Aligarh
ANTIBIOTIC RESISTANCE Syed Ziaur Rahman, MD, PhD D/O Pharmacology, JNMC, AMU, Aligarh WHY IS THIS IMPORTANT? The most important problem associated with infectious disease today is the rapid development
More informationImagine. Multi-Drug Resistant Superbugs- What s the Big Deal? A World. Without Antibiotics. Where Simple Infections can be Life Threatening
Multi-Drug Resistant Superbugs- What s the Big Deal? Toni Biasi, RN MSN MPH CIC Infection Prevention Indiana University Health Imagine A World Without Antibiotics A World Where Simple Infections can be
More informationAntibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIII NUMBER 1 July 2008 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell, SM (ASCP), Marti Roe SM (ASCP), Ann-Christine Nyquist MD, MSPH Are the bugs winning? The 2007
More informationHigh-Risk MDR clones news in treatment
Ferrara, 20 giugno 2013 High-Risk MDR clones news in treatment Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi Characteristics and determinants of outcome of hospital-acquired
More informationGlobal Alliance for Infections in Surgery. Better understanding of the mechanisms of antibiotic resistance
Better understanding of the mechanisms of antibiotic resistance Antibiotic prescribing practices in surgery Contents Mechanisms of antibiotic resistance 4 Antibiotic resistance in Enterobacteriaceae 9
More informationThe International Collaborative Conference in Clinical Microbiology & Infectious Diseases
The International Collaborative Conference in Clinical Microbiology & Infectious Diseases PLUS: Antimicrobial stewardship in hospitals: Improving outcomes through better education and implementation of
More informationAntibiotics 201: Gramnegatives
Antibiotics 201: Gramnegatives B. Joseph Guglielmo, Pharm.D. Professor and Dean School of Pharmacy University of California San Francisco Disclosures No potential conflicts of interest. 1 A 77 year old
More informationAppropriate Antimicrobial Therapy for Treatment of
Appropriate Antimicrobial Therapy for Treatment of Staphylococcus aureus infections ( MRSA ) By : A. Bojdi MD Assistant Professor Inf. Dis. Dep. Imam Reza Hosp. MUMS Antibiotics Still Miracle Drugs Paul
More informationANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES
ANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES 1 Crisis: Antibiotic Resistance Success Strategy 2 OBJECTIVES Discuss
More informationAntimicrobial Susceptibility Patterns
Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH Outline Methodology Overall KNH data Surgery department
More informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
More informationMedicinal Chemistry 561P. 2 st hour Examination. May 6, 2013 NAME: KEY. Good Luck!
Medicinal Chemistry 561P 2 st hour Examination May 6, 2013 NAME: KEY Good Luck! 2 MDCH 561P Exam 2 May 6, 2013 Name: KEY Grade: Fill in your scantron with the best choice for the questions below: 1. Which
More informationAntimicrobial stewardship in managing septic patients
Antimicrobial stewardship in managing septic patients November 11, 2017 Samuel L. Aitken, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases slaitken@mdanderson.org Conflict of interest
More informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
More informationSamantha Trumm, Pharm.D. PGY-1 Resident Avera McKennan Hospital and University Center
Samantha Trumm, Pharm.D. PGY-1 Resident Avera McKennan Hospital and University Center I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in
More informationDisclosures. Principles of Antimicrobial Therapy. Obtaining an Accurate Diagnosis Obtain specimens PRIOR to initiating antimicrobials
Disclosures Principles of Antimicrobial Therapy None Lori A. Cox MSN, ACNP-BC, ACNPC, FCCM Penn State Hershey Medical Center Neuroscience Critical Care Unit Obtaining an Accurate Diagnosis Determine site
More information