antimivrobial resistance gan
TRANSCRIPT
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Dr Gan
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Antibiotics-most commonly used group of
drugs
Antibiotic resistance-worlds most pressing
public health problems
Studies worldwide has shown a high incidence
of inappropriate use
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Although many countries have been
successful in reducing primary care
prescribing of antimicrobials, primary care is
still responsible for the majority ofantibiotics prescribed to people
To combat antimicrobial resistance
effectively, information is needed on
antibiotic use
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Avoid adverse effects on the patient
Avoid emergence of antibiotic resistance -
ecological or societal aspect of antibiotics
Avoid unnecessary increases in the cost ofhealth care
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Antibiotics differ from other classes ofdrugs
The way in which a physician and otherprofessionals use an antibiotic can
affect the response of future patients Responsibility to society Antibiotic resistance can spread from
bacteria to bacteria
patient to patient animals to patients
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Is an antibiotic necessary ?
What is the most appropriate antibiotic ?
What dose, frequency, route and duration ?
Is the treatment effective ?
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Useful only for the treatment of bacterial
infections
Not all fevers are due to infection
Not all infections are due to bacteria There is no evidence that antibiotics will
prevent secondary bacterial infection in
patients with viral infection
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Meta-analysis of 9 randomised placebo controlledtrials involving 2249 patients
Conclusions: There is not enough evidence ofimportant benefits from the treatment of upperrespiratory tract infections with antibiotics andthere is a significant increase in adverse effects
associated with antibiotic use.
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Aetiological agent
Patient factors
Antibiotic factors
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In most instances the optimum duration is
unknown
Duration varies from a single dose to many
months depending on the infection Shorter durations, higher doses
For certain infections a minimum duration is
recommended
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Infection Minimum duration
Tuberculosis 4 - 6 months
Empyema/lung abscess 4 - 6 weeksEndocarditis 4 weeks
Osteomyelitis 4 weeks
Atypical pneumonia 2 - 3 weeks
Pneumococcal meningitis 7 daysPneumococcal
pneumonia
5 days
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Lower threshold for antibiotics in
immunocompromised hosts or those with
multiple comorbidities; consider culture and
seek advice
Prescribe an antibiotic only when there is
likely to be a clear clinical benefit
Consider NO antibiotic strategy for acute
self-limiting upper respiratory tract
infections
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Use narrow spectrum antibiotics when
possible
Avoid broad spectrum antibiotics eg co-
amoxiclav, quinolones and cephalosporins Avoid widespread use of topical antibiotics
e.g. fusidic acid
Where a best guess therapy has failed or
special circumstances exist, seek advice fromPhysicians/ID/Clinical Microbiologists.
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Enterobacter
Staphylococcus aureus (MRSA) Klebsiella ( ESBL , CRE )
Acinetobacter (MDR,XDR ,PDR)
Pseudomonas aeruginosae Enterococcus (VRE)
Boucher HW et al, Clin Infect Dis 2009 ;48:1-12
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MRSA = methicillin-resistant Staphylococcus aureus; VRE = Vancomycin-resistant enteroccoci
FQRP = Fluoroquinolone-resistant Pseudomonas aeruginosa
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Susceptibility of members of the family Enterobacteriaceae and bacteria that were notmembers of the Enterobacteriaceae to imipenem and ciprofloxacin from 2002 to 2008.
Hoban D J et al. Antimicrob. Agents Chemother.2010;54:3031-3034
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Percenta
ge
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0
10
20
30
4050
60
70
80
90
0
10
20
30
4050
60
70
0
10
20
30
4050
60
70
80
Acinetobacter species resistance : IMR (%)
ICU MEDICAL
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Resistance Profile 2008 2009 2010 2011
% Acinetobacterspresistant
Amikacin, Ceftazidime,
Cefepime,
Cefoperazone / sulb,
Ciprofloxacin,Meropenem
7.4 11.8 15.2 17.7
Common among Acinetobacter spp.
Usually encountered in ICU
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Predicted mortality for patients with and withoutantimicrobial-resistant infection (ARI)
Roberts R R et al. Clin Infect Dis. 2009;49:1175-1184
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Source: US CDC 2010
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Spellberg, CID 2004
Approvals
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Strengthen Infection Control measures toreduce spread of resistant organismsRationalize the use of available antimicrobial
agentsPrevent emergence of resistance by reducing
selection pressure by appropriate control
measures
Promote discovery, development anddissemination of new antimicrobial agents
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Projected cost savings if antimicrobial-resistantinfection (ARI) rates were reduced from 13.5% to
10%.
Roberts R R et al. Clin Infect Dis. 2009;49:1175-1184
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Purpose :
To remove dirt, debris & reducemicrobes from hand
To reduce cross contamination /infection
To interrupt mode of transmission bycontact
Image of cleanliness, credibility of HCW
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Prevent infection
Vaccinate
Get the catheter out
Diagnose and treat infection effectively Target the pathogen
Access the expert
Use antimicrobial wisely
Practice antimicrobial control
Use local data
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Treat infection, not contamination
Treat infection, not colonization
Know when to say no to vancomycin
Stop treatment when infection is cured or
unlikely
Prevent transmission
Isolate the pathogen
Break the chain of contagion
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