antimivrobial resistance gan

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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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