Microbiology Basics and Applications to Clinical Practice
|
|
- Hugo Franklin
- 6 years ago
- Views:
Transcription
1 Microbiology Basics and Applications to Clinical Practice LINDSEY CHILDS-KEAN, PHARMD, MPH, BCPS CLINICAL ASSISTANT PROFESSOR UNIVERSITY OF FLORIDA COLLEGE OF PHARMACY ST. PETERSBURG, FL Disclosures I do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with an organization whose philosophy could potentially bias my presentation 1
2 Pharmacist Objectives By the end of the presentation, learners should be able to: Discuss susceptibility testing and how it impacts treatment Compare and contrast the mechanisms of antimicrobial resistance Explain the role of antibiograms in clinical practice Given a patient case, determine which antimicrobial agent (s) would be most effective for treatment Technician Objectives By the end of the presentation, learners should be able to: Discuss susceptibility testing and how it impacts treatment Compare and contrast the mechanisms of antimicrobial resistance 2
3 The time has come to close the book on infectious diseases. We have basically wiped out infection in the United States. -attributed to Dr. William Stewart, United States Surgeon General Spellberg B. Infect Dis Poverty 2013;2:3. If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. -Dr. Margaret Chan, Director-General of the World Health Organization World Health Organization
4 Susceptibility Testing Definitions Term Minimum Inhibitory Concentration (MIC) Susceptible (S) Susceptible-Dose Dependent (SDD) Intermediate (I) Resistant (R) Definition Lowest concentration that inhibits bacterial growth MIC at or below concentration expected with usual antibiotic dosing Susceptibility is dependent on dose of antibiotic used MIC at concentration expected with higher antibiotic dosing MIC higher than concentration expected with therapeutic doses Jorgenson J. Clin Infect Dis 2009;49: Clinical and Laboratory Standards Institute Murray PR. Principles and Practices of Infectious Disease. Ch. 17,
5 Gram Positive Organisms Bacilli Bacillus, Listeria, Corynebacterium, Lactobacillus Gram Positive Streptococcus Pairs & Chains Cocci Enterococcus Clusters Staphylococcus Murray PR. Principles and Practices of Infectious Disease. Ch. 17, Gram Negative Organisms Cocci Neisseria, Moraxella Gram Negative Lactose Fermenter E. coli, Klebsiella, Enterobacter, Serratia, Citrobacter Bacilli Lactose Nonfermenter Pseudomonas Morganella, Proteus, Acinetobacter Murray PR. Principles and Practices of Infectious Disease. Ch. 17,
6 Types of Susceptibility Testing Broth Dilution Tests Antimicrobial Gradient Method Disk Diffusion Test Automated Instrument Systems Jorgenson J. Clin Infect Dis 2009;49: Patient Case 44 year old diabetic male presents with foot wound He describes 3 days of erythema and pain at the site of the wound and subjective fever The physician empirically places the patient on clindamycin He had wound cultures taken and preliminary reports show Gram positive cocci in clusters What organism(s) should you suspect at this point? Staphylococcus spp. 6
7 Patient Case Lewis JS. Clin Infect Dis. 2005;40: Patient Case Drug MIC (mg/ml) Interpretati on Benzylpenicillin > 16 R Oxacillin < 2 S Erythromycin > 8 R Clindamycin > 8 R Tetracycline < 1 S Trimethoprim/ Sulfamethoxazole < 10 S Vancomycin 1 S 7
8 WHEN DOES MIC MATTER? Vancomycin For Staphylococcus sp.: Susceptible range: < 2 mcg/ml Clinical failures seen with MICs > 1mcg/mL Soriano A. Clin Infect Dis 2008;46: Murray KP. Clin Infect Dis 2013;56:
9 Cefepime- S-DD Category for Enterobacteriaceae Prior to 2014, Intermediate Category Method Susceptible Intermediate Resistant MIC < 8 mcg/ml 16 mcg/ml > 32 mcg/ml Zone Diameter > 18 mm mm < 14 mm Now, Susceptible-Dose Dependent Category Method Susceptible* Susceptible-Dose Dependent Resistant MIC < 2 mcg/ml 4-8 mcg/ml > 16 mcg/ml Zone Diameter > 25 mm mm < 18 mm *Susceptible based on cefepime dose of 1 gram every 12 hours Clinical and Laboratory Standards Institute Antibacterial Resistance 9
10 Why Do Bacteria Become Resistant to Antibiotics? We are trying to kill them. They are trying to eat and reproduce What would YOU do if someone was trying to kill you while you were trying to eat and/or reproduce? -Stephen B. Brecher, Ph.D. Brecher SB. Microbiology for Stewardship June Types of Bacterial Resistance Intrinsic Extrinsic (acquired) Opal SM. Principles and Practices of Infectious Disease. Ch. 19,
11 Mechanisms of Bacterial Resistance Levy S. Nat Med 2010;10:S Enzymatic Alteration Classic Example: Beta-lactamase Hydrolyze beta-lactam ring Ambler Class Enzyme Type(s) Antibiotic(s) Affected Examples A Penicillinases ESBLs Carbapenemases PCNs, narrow cephs PCNs, most cephs All beta-lactams TEM, SHV, CTX KPC B Carbapenemases All beta-lactams IMP, VIM, SPM, NDM C Cephalosporinases Most cephalosporins AMP C D Oxacillinases ESBLs Carbapenemases PCNs, narrow cephs PCNs, most cephs All beta-lactams OXA PCNs: penicillins, Cephs: cephalosporins, ESBLs: Extended-spectrum beta-lactamases Opal SM. Principles and Practices of Infectious Disease. Ch. 19,
12 Beta-Lactamases Solution: Add beta-lactamase inhibitor Amoxicillin/clavulanic acid Ampicillin/sulbactam Ticarcillin/clavulanic acid Piperacillin/tazobactam Solution: Use beta-lactam that is stable Solution: Use alternate class(es) of antibiotics Opal SM. Principles and Practices of Infectious Disease. Ch. 19, Clinical Pearl Most beta-lactamases produced by anaerobes are inhibited by beta-lactamase inhibitors No need for double anaerobic coverage! Opal SM. Principles and Practices of Infectious Disease. Ch. 19,
13 Other Enzymatic Alteration Aminoglycoside Resistance-Modifying Enzymes Chloramphenicol Acetyltransferase Macrolide Inactivation Tetracycline Inactivation Opal SM. Principles and Practices of Infectious Disease. Ch. 19, Alteration of Target Site Change in site of action of antibiotic Example: Change in ribosomal binding sites Macrolides, Lincosamides, Streptogramins Gram positive bacteria Mediated by erythromycin ribosome methylation (erm) genes Constitutive or inducible Solution: Recognize inducible resistance in micro Solution: Increase concentration of drug Solution: Use alternate antibiotic class Opal SM. Principles and Practices of Infectious Disease. Ch. 19,
14 Other Target Alterations Beta-lactams Fluoroquinolones Aminoglycosides Oxazolidinones Glycopeptides Sulfonamides Opal SM. Principles and Practices of Infectious Disease. Ch. 19, Efflux Membrane transport system removing antibiotic Major mechanism of resistance in Gram negatives to tetracyclines Inner membrane protein produced by tetracyclineresistance determinant (tet) Inducible by low concentrations of tetracyclines Solution: Ensure adequate concentrations Solution: Use alternate antibiotic class Opal SM. Principles and Practices of Infectious Disease. Ch. 19,
15 Other Efflux Macrolides and Streptogramins Beta-lactams Fluoroquinolones Opal SM. Principles and Practices of Infectious Disease. Ch. 19, Decreased Permeability Ceccarelli M. Frontiers in Bioscience 2009;14:
16 Decreased Permeability Not primary mechanism of resistance Present in resistance to many antibiotic classes Beta-lactams Aminoglycosides Macrolides Fluoroquinolones Solution: Use alternate antibiotic class Opal SM. Principles and Practices of Infectious Disease. Ch. 19, Bacteria Can Mix and Match Multi-drug resistant bacteria can have multiple mechanisms of resistance May require unique combinations of antibiotics May require pharmacokinetic/pharmacodynamic optimization Infectious Disease Consult (+ Infectious Disease Pharmacist) Opal SM. Principles and Practices of Infectious Disease. Ch. 19,
17 Antibiograms Basics Summary of susceptibilities of local isolates Should be done at least annually Include only species with at least 30 isolates Only diagnostic cultures (no screening cultures) Only first isolate included Report percent susceptible (%S) Clinical and Laboratory Standards Institute
18 Goal Guide practitioners in selection of appropriate antimicrobials for EMPIRIC management Can also be used to track resistance rates over time Clinical and Laboratory Standards Institute Example Duke University Medical Center Clinical Microbiology Laboratory,
19 Clinical Scenario Your Pharmacy Clinical Coordinator asks you to reevaluate your preferred aminoglycoside for empiric use. He wants to ensure the greatest efficacy against Pseudomonas aeruginosa. Clinical Scenario Duke University Medical Center Clinical Microbiology Laboratory,
20 Clinical Scenario Which aminoglycoside do you recommend to your Clinical Coordinator? A. Amikacin B. Gentamicin C. Tobramycin Patient Case TG is a 32 year old non-pregnant female who presents to clinic with dysuria but is afebrile and denies flank pain. She is able to tolerate oral medication and has no known allergies. She is diagnosed with an uncomplicated urinary tract infection (UTI). The 2010 IDSA Uncomplicated UTI Guidelines state that sulfamethoxazole/trimethoprim is an option if local resistance rate is not greater than 20%. Gupta K. Clin Infect Dis 2011;52:e103-e
21 Patient Case Duke University Medical Center Clinical Microbiology Laboratory, Patient Case Which of the following is TRUE regarding the empiric use of sulfamethoxazole/trimethoprim in this patient? A. Sulfamethoxazole/trimethoprim local resistance is less than 20%; therefore, it is an option. B. Sulfamethoxazole/trimethoprim should not be used empirically as resistance is greater than 20%. 21
22 Patient Case Continued TG s urine culture came back as shown below: Organism: E. coli Drug Ampicillin Cefazolin Cefepime Ceftriaxone Ciprofloxacin Ertapenem Gentamicin Meropenem Nitrofurantoin Sulfamethoxazole/Trimethoprim Interpretation R R R R R S S S S S Patient Case Continued Which of the following is TRUE regarding TG s urine culture? A. Ciprofloxacin is the preferred regimen for this patient. B. Sulfamethoxazole/trimethoprim is an option based on urine culture results. C. The isolate is only susceptible to IV antibiotics. D. Nitrofurantoin is the only oral antibiotic option. 22
23 Summary There are 4 main mechanisms of antibiotic resistance Susceptibility testing is the mainstay of directing antibiotic therapy Antibiograms help guide clinicians in choosing appropriate empiric antibiotic therapy References Brecher SB. Microbiology for Stewardship. Powerpoint presentation. Antimicrobial Stewardship Task Force Monthly Webinar. June 26, Ceccarelli M. Simulating transport properties through bacterial channels. Frontiers in Bioscience 2009;14: CLSI. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data; Approved Guideline-Fourth Edition. CLSI document M39-A4. Wayne, PA: Clinical and Laboratory Standards Institute; CLSI. Cefepime Breakpoint Change for Enterobacteriaceae and Introduction of the Susceptible- Dose Dependent (SDD) Interpretation Category. July Accessed March 30, 2014 at Duke University Medical Center Clinical Microbiology Laboratory. Summary of antimicrobial susceptibility testing February Accessed April 27, 2014 at Gupat K, Heoton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Disease Society of American and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-e120. Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis 2009;49:
24 References Levy SB, Marshall B. Antibacterial resistance worldwide: causes, challenges, and responses. Nat Med 2004;10:S Lewis JS, Jorgensen JH. Inducible clindamycin resistance in staphylococci: should clinicians and microbiologists be concerned? Clin Infect Dis 2005;40: Murray KP, Zhao JJ, Davis SL, et al. Early use of daptomycin versus vancomycin for methicillinresistant Staphylococcus aureus bacteremia with vancomycin minimum inhibitory concentration > 1mg/L: a matched cohort study. Clin Infect Dis 2013;56: Murray PR, Witebsky FG. The Clinician and the Microbiology Laboratory. In Mandell, Douglas, and Bennett s Principles and Practice of Infectious Diseases. 7 th ed Opal SM, Pop-Vicas, A. Molecular Mechanisms of Antibiotic Resistance in Bacteria. In Mandell, Douglas, and Bennett s Principles and Practice of Infectious Diseases. 7 th ed Soriano A, Marco F, Martinez J, et al. Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureusbacteremia. Clin Infect Dis 2008;46: Spellberg B, Taylor-Blake B. On the exoneration of Dr. William H. Stewart: debunking an urban legend. Infect Dis Poverty 2013;2:3. World Health Organization. Antimicrobial resistance in the European Union and the world. March Accessed April 27, 2014 at Question 1 Which of the following susceptibility terms has the following definition: Susceptibility is determined by the antibiotic dose used. A. Susceptible B. Susceptible-Dose Dependent C. Intermediate D. Resistant 24
25 Question 2 Which of the following is NOT a bacterial mechanism of resistance? A. Efflux B. Enzyme Alteration C. Decreased Permeability D. None of the above- all ARE mechanisms of resistance Question 3 Which of the following is the primary goal of an antibiogram? A. Guide empiric antibiotic therapy B. Guide culture result-directed antibiotic therapy C. Determine most cost-effective antibiotic D. None of the above 25
26 Questions? Lindsey Childs-Kean, PharmD, MPH, BCPS 26
48 th Annual Meeting. Microbiology 101: What You Wish You Had Learned in Pharmacy School. Disclosures. Objectives. Susceptibility Testing 7/19/2014
48 th Annual Meeting Microbiology 101: What You Wish You Had Learned in Pharmacy chool Lindsey Childs-Kean, PharmD, MPH, BCP Clinical Assistant Professor University of Florida College of Pharmacy t. Petersburg,
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 informationAntimicrobial Stewardship Strategy: Antibiograms
Antimicrobial Stewardship Strategy: Antibiograms A summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region. Its main functions are to guide
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 informationAberdeen Hospital. Antibiotic Susceptibility Patterns For Commonly Isolated Organisms For 2015
Aberdeen Hospital Antibiotic Susceptibility Patterns For Commonly Isolated s For 2015 Services Laboratory Microbiology Department Aberdeen Hospital Nova Scotia Health Authority 835 East River Road New
More informationUnderstanding the Hospital Antibiogram
Understanding the Hospital Antibiogram Sharon Erdman, PharmD Clinical Professor Purdue University College of Pharmacy Infectious Diseases Clinical Pharmacist Eskenazi Health 5 Understanding the Hospital
More informationجداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی
جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی ویرایش دوم بر اساس ed., 2017 CLSI M100 27 th تابستان ۶۹۳۱ تهیه
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 informationThe Basics: Using CLSI Antimicrobial Susceptibility Testing Standards
The Basics: Using CLSI Antimicrobial Susceptibility Testing Standards Janet A. Hindler, MCLS, MT(ASCP) UCLA Health System Los Angeles, California, USA jhindler@ucla.edu 1 Learning Objectives Describe information
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 information2016 Antibiotic Susceptibility Report
Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates
More informationConcise Antibiogram Toolkit Background
Background This toolkit is designed to guide nursing homes in creating their own antibiograms, an important tool for guiding empiric antimicrobial therapy. Information about antibiograms and instructions
More information2015 Antibiotic Susceptibility Report
Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
More informationAntimicrobial susceptibility
Antimicrobial susceptibility PATTERNS Microbiology Department Canterbury ealth Laboratories and Clinical Pharmacology Department Canterbury District ealth Board March 2011 Contents Preface... Page 1 ANTIMICROBIAL
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 informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIX NUMBER 3 November 2014 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell SM MLS (ASCP), Marti Roe SM MLS (ASCP), Sarah Parker MD, Jason Child PharmD, and Samuel R.
More informationAntimicrobial Susceptibility Testing: The Basics
Antimicrobial Susceptibility Testing: The Basics Susan E. Sharp, Ph.D., DABMM, FAAM Director, Airport Way Regional Laboratory Director, Regional Microbiology and Molecular Infectious Diseases Laboratories
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 informationSuggestions for appropriate agents to include in routine antimicrobial susceptibility testing
Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory
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 informationTHE NAC CHALLENGE PANEL OF ISOLATES FOR VERIFICATION OF ANTIBIOTIC SUSCEPTIBILITY TESTING METHODS
THE NAC CHALLENGE PANEL OF ISOLATES FOR VERIFICATION OF ANTIBIOTIC SUSCEPTIBILITY TESTING METHODS Stefanie Desmet University Hospitals Leuven Laboratory medicine microbiology stefanie.desmet@uzleuven.be
More informationa. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2.
AND QUANTITATIVE PRECISION (SAMPLE UR-01, 2017) Background and Plan of Analysis Sample UR-01 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony
More informationEuropean Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control for MIC determination and disk diffusion as recommended by EUCAST Version 8.0, valid from 018-01-01
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 informationMercy Medical Center Des Moines, Iowa Department of Pathology. Microbiology Department Antibiotic Susceptibility January December 2016
Mercy Medical Center Des Moines, Iowa Department of Pathology Microbiology Department Antibiotic Susceptibility January December 2016 These statistics are intended solely as a GUIDE to choosing appropriate
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 informationTable 1. Commonly encountered or important organisms and their usual antimicrobial susceptibilities.
Table 1. Commonly encountered or important organisms and their usual antimicrobial susceptibilities. Gram-positive cocci: Staphylococcus aureus: *Resistance to penicillin is almost universal. Resistance
More informationEducating Clinical and Public Health Laboratories About Antimicrobial Resistance Challenges
Educating Clinical and Public Health Laboratories About Antimicrobial Resistance Challenges Janet Hindler, MCLS MT(ASCP) UCLA Medical Center jhindler@ucla.edu also working as a consultant with the Association
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 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 informationHelp with moving disc diffusion methods from BSAC to EUCAST. Media BSAC EUCAST
Help with moving disc diffusion methods from BSAC to EUCAST This document sets out the main differences between the BSAC and EUCAST disc diffusion methods with specific emphasis on preparation prior to
More informationRCH antibiotic susceptibility data
RCH antibiotic susceptibility data The following represent RCH antibiotic susceptibility data from 2008. This data is used to inform antibiotic guidelines used at RCH. The data includes all microbiological
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimum Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) Broth dilution: cation-adjusted Mueller-Hinton
More informationESBL- and carbapenemase-producing microorganisms; state of the art. Laurent POIREL
ESBL- and carbapenemase-producing microorganisms; state of the art Laurent POIREL Medical and Molecular Microbiology Unit Dept of Medicine University of Fribourg Switzerland INSERM U914 «Emerging Resistance
More informationESBL Producers An Increasing Problem: An Overview Of An Underrated Threat
ESBL Producers An Increasing Problem: An Overview Of An Underrated Threat Hicham Ezzat Professor of Microbiology and Immunology Cairo University Introduction 1 Since the 1980s there have been dramatic
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimal Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) roth dilution: cation-adjusted Mueller-Hinton
More information2016 Antibiogram. Central Zone. Alberta Health Services. including. Red Deer Regional Hospital. St. Mary s Hospital, Camrose
2016 Antibiogram Central Zone Alberta Health Services including Red Deer Regional Hospital St. Mary s Hospital, Camrose Introduction This antibiogram is a cumulative report of the antimicrobial susceptibility
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 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 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 information11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1
Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director
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 informationEuropean Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control as recommended by EUCAST Version 5.0, valid from 015-01-09 This document should be cited as "The
More informationInteractive session: adapting to antibiogram. Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe
Interactive session: adapting to antibiogram Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe Case 1 63 y old woman Dx: urosepsis? After 2 d: intermediate result: Gram-negative bacilli Empiric antibiotic
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 informationADC 2016 Report on Bacterial Resistance in Cultures from SEHOS and General Practitioners in Curaçao
ADC 216 Report on Bacterial Resistance in Cultures from SEHOS and General Practitioners in Curaçao Willemstad, November 217 Authors: Radjin Steingrover clinical microbiologist, head dpt. Microbiology ADC
More informationChildrens Hospital Antibiogram for 2012 (Based on data from 2011)
Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Prepared by: Department of Clinical Microbiology, Health Sciences Centre For further information contact: Andrew Walkty, MD, FRCPC Medical
More information2017 Antibiogram. Central Zone. Alberta Health Services. including. Red Deer Regional Hospital. St. Mary s Hospital, Camrose
2017 Antibiogram Central Zone Alberta Health Services including Red Deer Regional Hospital St. Mary s Hospital, Camrose Introduction This antibiogram is a cumulative report of the antimicrobial susceptibility
More informationLeveraging the Lab and Microbiology Department to Optimize Stewardship
Leveraging the Lab and Microbiology Department to Optimize Stewardship Presented by: Andrew Martinez MLS(ASCP), MT(AMT), MBA Alaska Native Medical Center Microbiology Supervisor Maniilaq Health Center
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 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 informationEUCAST recommended strains for internal quality control
EUCAST recommended strains for internal quality control Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus influenzae ATCC 59 ATCC
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 information56 Clinical and Laboratory Standards Institute. All rights reserved.
Table 2C 56 Clinical and Laboratory Standards Institute. All rights reserved. Table 2C. Zone Diameter and Minimal Inhibitory Concentration Breakpoints for Testing Conditions Medium: Inoculum: diffusion:
More informationDo clinical microbiology laboratory data distort the picture of antibiotic resistance in humans and domestic animals?
Do clinical microbiology laboratory data distort the picture of antibiotic resistance in humans and domestic animals? Scott Weissman, MD 2 June 2018 scott.weissman@seattlechildrens.org Disclosures I have
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 informationBACTERIAL SUSCEPTIBILITY REPORT: 2016 (January 2016 December 2016)
BACTERIAL SUSCEPTIBILITY REPORT: 2016 (January 2016 December 2016) VA Palo Alto Health Care System April 14, 2017 Trisha Nakasone, PharmD, Pharmacy Service Russell Ryono, PharmD, Public Health Surveillance
More information2015 Antimicrobial Susceptibility Report
Gram negative Sepsis Outcome Programme (GNSOP) 2015 Antimicrobial Susceptibility Report Prepared by A/Professor Thomas Gottlieb Concord Hospital Sydney Jan Bell The University of Adelaide Adelaide On behalf
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 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 informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXXII NUMBER 6 September 2017 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell SM MLS (ASCP), Stacey Hamilton MT SM (ASCP), Samuel Dominguez MD PhD, Sarah Parker MD, and
More informationAntimicrobial Chemotherapy
2016 edition by Claudine El-Beyrouty, PharmD, BCPS Department of Pharmacy Thomas Jefferson University Hospital Brian Roslund, PharmD, BCPS, AQ-ID Department of Pharmacy Thomas Jefferson University Hospital
More informationInitial Management of Infections in the Era of Enhanced Antimicrobial Resistance
Initial Management of Infections in the Era of Enhanced Antimicrobial Resistance Robert C Welliver Sr, MD Hobbs-Recknagel Endowed Chair in Pediatrics Chief, Pediatric infectious Diseases Children s Hospital
More informationAntimicrobial Resistance Trends in the Province of British Columbia
655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel 604.707.2443 Fax 604.707.2441 www.bccdc.ca Antimicrobial Resistance Trends in the Province of British Columbia 2013 Prepared by the Do Bugs Need Drugs? Program
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 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 informationHelen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory
METHODS USED IN NEW ZEALAND DIAGNOSTIC LABORATORIES TO IDENTIFY AND REPORT EXTENDED-SPECTRUM β-lactamase- PRODUCING ENTEROBACTERIACEAE by Helen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory
More informationAntibiotic Stewardship Program (ASP) CHRISTUS SETX
Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
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 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 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 informationAntimicrobial Resistance Strains
Antimicrobial Resistance Strains Microbiologics offers a wide range of strains with characterized antimicrobial resistance mechanisms including: Extended-Spectrum β-lactamases (ESBLs) Carbapenamases Vancomycin-Resistant
More informationAntimicrobial Pharmacodynamics
Antimicrobial Pharmacodynamics November 28, 2007 George P. Allen, Pharm.D. Assistant Professor, Pharmacy Practice OSU College of Pharmacy at OHSU Objectives Become familiar with PD parameters what they
More informationAntimicrobial Stewardship:
Antimicrobial Stewardship: Inpatient and Outpatient Elements Angela Perhac, PharmD afperhac@carilionclinic.org Disclosure I have no relevant finances to disclose. Objectives Review the core elements of
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 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 informationPrinciples of Infectious Disease. Dr. Ezra Levy CSUHS PA Program
Principles of Infectious Disease Dr. Ezra Levy CSUHS PA Program I. Microbiology (1) morphology (e.g., cocci, bacilli) (2) growth characteristics (e.g., aerobic vs anaerobic) (3) other qualities (e.g.,
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 informationESCMID Online Lecture Library. by author
Expert rules in susceptibility testing EUCAST-ESGARS-EPASG Educational Workshop Linz, 16 19 September, 2014 Dr. Rafael Cantón Hospital Universitario Ramón y Cajal SERVICIO DE MICROBIOLOGÍA Y PARASITOLOGÍA
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 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 informationIntroduction to Pharmacokinetics and Pharmacodynamics
Introduction to Pharmacokinetics and Pharmacodynamics Diane M. Cappelletty, Pharm.D. Assistant Professor of Pharmacy Practice Wayne State University August, 2001 Vocabulary Clearance Renal elimination:
More informationA retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya
A retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya LU Edirisinghe 1, D Vidanagama 2 1 Senior Registrar in Medicine, 2 Consultant Microbiologist,
More informationPrinciples and Practice of Antimicrobial Susceptibility Testing. Microbiology Technical Workshop 25 th September 2013
Principles and Practice of Antimicrobial Susceptibility Testing Microbiology Technical Workshop 25 th September 2013 Scope History Why Perform Antimicrobial Susceptibility Testing? How to Perform an Antimicrobial
More information1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient
1 Chapter 79, Self-Assessment Questions 1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is: A. Trimethoprim-sulfamethoxazole B. Cefuroxime
More informationApproach to pediatric Antibiotics
Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus
More informationHow is Ireland performing on antibiotic prescribing?
European Antibiotic Awareness Campaign 2016 November Webinar Series on Antibiotic Prescribing How is Ireland performing on antibiotic prescribing? Dr Rob Cunney National Clinical Lead HCAI AMR Clinical
More informationBacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota
Bacterial Resistance of Respiratory Pathogens John C. Rotschafer, Pharm.D. University of Minnesota Antibiotic Misuse ~150 million courses of antibiotic prescribed by office based prescribers Estimated
More informationCLINICAL USE OF BETA-LACTAMS
CLINICAL USE OF BETA-LACTAMS Douglas Black, Pharm.D. Associate Professor School of Pharmacy University of Washington dblack@u.washington.edu WHY IS INFECTIOUS DISEASE PHARMACOTHERAPY SO CONFUSING? Microbial
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 informationEinheit für pädiatrische Infektiologie Antibiotics - what, why, when and how?
Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Andrea Duppenthaler andrea.duppenthaler@insel.ch Limping patient local pain swelling tenderness warmth fever acute Osteomyelitis
More informationWhat s new in EUCAST methods?
What s new in EUCAST methods? Derek Brown EUCAST Scientific Secretary Interactive question 1 MIC determination MH-F broth for broth microdilution testing of fastidious microorganisms Gradient MIC tests
More informationComparative Assessment of b-lactamases Produced by Multidrug Resistant Bacteria
Comparative Assessment of b-lactamases Produced by Multidrug Resistant Bacteria Juhee Ahn Department of Medical Biomaterials Engineering Kangwon National University October 23, 27 Antibiotic Development
More informationSuper Bugs and Wonder Drugs: Protecting the One While Respecting the Many
Super Bugs and Wonder Drugs: Protecting the One While Respecting the Many Vicki Stringfellow, MSN, CPNP-AC/PC Werner Division of Pediatric Critical Care University of Kentucky Lexington, KY Disclosure
More informationEARS Net Report, Quarter
EARS Net Report, Quarter 4 213 March 214 Key Points for 213* Escherichia coli: The proportion of patients with invasive infections caused by E. coli producing extended spectrum β lactamases (ESBLs) increased
More informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXVII NUMBER 6 July 2012 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine B. Dowell SM, MLS (ASCP); Sarah K. Parker, MD; James K. Todd, MD Each year the Children s Hospital Colorado
More informationCipro for gram positive cocci in urine
Buscar... Cipro for gram positive cocci in urine 20-6-2017 Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the alveolar
More informationBackground and Plan of Analysis
ENTEROCOCCI Background and Plan of Analysis UR-11 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony count, to perform the identification
More information