抗生素PPT课件(英文精品) Resistance to antibiotics
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--抗生素PPT课件(英文精品)Antibiotic resistancea new
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
Recent initiatives
• European Antibiotic Awareness Day • EU/US transatlantic task force on antibiotic
resistance • A conference on incentives for effective antibiotics
hosted by the Swedish EU presidency
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
An increasing problem is resistance among Gram-negative bacteria
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
Recent initiatives
• European Antibiotic Awareness Day • EU/US transatlantic task force on antibiotic
resistance • A conference on incentives for effective antibiotics
hosted by the Swedish EU presidency
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
An increasing problem is resistance among Gram-negative bacteria
Hans Wolf-Watz, professor, UCMR, MIMS, Department of Microbiology, UmeåUniversity, Sweden, www.ucmr.se, www.molbiol.umu.se
抗生素PPT课件(英文精品) Miscellaneous Antibiotics
Diarrhea , nausea, Skicolitis Impaired liver function Neutropenia ( not common )
Vancomycin
Bactericidal
Inhibits bacterial cell wall synthesis
Bacitracin
Bactericidal Inhibits cell wall synthesis Active against gram +ve organisms
associated enterocolitis
Adverse effects
Phlebitis at the site of infusion Fever Ototoxicity & nephrotoxicity ( not common). Red man or red neck syndrome. Hypotension
tissues except brain &CSF. Penetrates well into abscess & is taken up
by phagocytic cells.
Metabolized by the liver.
Both active drug & active metabolites are excreted in bile & urine
infections. Widely distributed Cerebrospinal fluid levels are achieved in
meningeal inflammation Excreted mainly through renal route
Vancomycin
Bactericidal
Inhibits bacterial cell wall synthesis
Bacitracin
Bactericidal Inhibits cell wall synthesis Active against gram +ve organisms
associated enterocolitis
Adverse effects
Phlebitis at the site of infusion Fever Ototoxicity & nephrotoxicity ( not common). Red man or red neck syndrome. Hypotension
tissues except brain &CSF. Penetrates well into abscess & is taken up
by phagocytic cells.
Metabolized by the liver.
Both active drug & active metabolites are excreted in bile & urine
infections. Widely distributed Cerebrospinal fluid levels are achieved in
meningeal inflammation Excreted mainly through renal route
抗生素PPT课件(英文精品) Antibiotics and Pain Control
– Fullen, et al.
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
General Preventive Measures
• Adequate and Timely Resuscitation
• Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis
Adequate and Timely Resuscitation
Why not?!
• Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for
medic training).
• Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect.
• Debridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
General Preventive Measures
• Adequate and Timely Resuscitation
• Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis
Adequate and Timely Resuscitation
Why not?!
• Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for
medic training).
• Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect.
• Debridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
抗生素PPT课件(英文精品) TOWARDS THE RATIONAL USE OF ANTIBIOTICS
A r g e n tin a Egypt
B r a s il
• Antibiotics are
Rw anda
prescribed in 79% of the
encounters with general
Ethiopia
pria
0% 10% 20% 30% 40% 50% 60%
may not be the clue. Soc Sci Med. 1996. 42(8): p1141-53
Determinants of irrational use (II)
Prescribers Lack of appropriate knowledge
Lack / delayed lab results, fear of clinical failures Inappropriate peer norms, local medical cultures Economic incentives
Avorn, J. and D.H. Solomon, Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann Intern Med, 2000. 133(2): p. 128-35.
• An understanding of the determinants of antibiotic consumption is critical to explain current patterns of use and to devise programmes to improve their rational use.
B r a s il
• Antibiotics are
Rw anda
prescribed in 79% of the
encounters with general
Ethiopia
pria
0% 10% 20% 30% 40% 50% 60%
may not be the clue. Soc Sci Med. 1996. 42(8): p1141-53
Determinants of irrational use (II)
Prescribers Lack of appropriate knowledge
Lack / delayed lab results, fear of clinical failures Inappropriate peer norms, local medical cultures Economic incentives
Avorn, J. and D.H. Solomon, Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann Intern Med, 2000. 133(2): p. 128-35.
• An understanding of the determinants of antibiotic consumption is critical to explain current patterns of use and to devise programmes to improve their rational use.
抗生素PPT课件(英文精品) Proper Use of Antibiotics
Points to note when taking antibiotics (1)
➢ Follow your doctor’s instruction.
➢ Take the drugs on the right time at the right dose.
➢ If you miss one dose, take it as soon as you remember but never take a double dose.
Always consult your doctor for the use of antibiotics.
FAQ If I have fever, do I always need an antibiotic?
Fever is a common symptom for infections and not necessarily caused by bacterial infection.
抗生素PPT课件（英文精品） Proper Use of Antibiotics
Antibiotics
Antibiotics ≠ Anti-inflammatory drugs
Antibiotics ≠Panacea
Are there any risks for the use of antibiotics?
diarrhoea
Side effects of Antibiotics (2)
Allergic reaction - rash - itchiness - breathlessness
Antibiotic resistant bacteria
Predispose to the emergences of antibiotics resistant bacteria.
抗生素PPT课件英文精品ANTIBIOTICRESISTANTPATHOGENSIMPACTANDCONTROL104p
Systemic: Sepsis, bacteremia, endocarditis Organ system: Meningitis, osteomyelitis, septic arthritis, paratitis,
myositis
Evolution of Antimicrobial Resistance in Gram-positive Cocci
Deaths: 20,000
Source: Centers for Disease Control. MMWR 1997;46(RR-8)
% of Isolates Resistant to Penicillin
Trend for Penicillin-Resistant (MIC 2 mg/ml) S. pneumoniae in the US (1988-2002)
CHALLENGES IN THE PREVENTION AND MANAGEMENT OF HEALTHCARE-ASSOCIATED INFECTIONS
Changing population of hospital patients
Increased severity of illness Increased numbers of immunocompromised patients Shorter duration of hospitalization More and larger intensive care units
Pneumonia: 967 (46.9%) Other lower respiratory tract: 368 (17.8%) Urinary tract: 363 (17.6%) Bloodstream: 247 (12.0%)
myositis
Evolution of Antimicrobial Resistance in Gram-positive Cocci
Deaths: 20,000
Source: Centers for Disease Control. MMWR 1997;46(RR-8)
% of Isolates Resistant to Penicillin
Trend for Penicillin-Resistant (MIC 2 mg/ml) S. pneumoniae in the US (1988-2002)
CHALLENGES IN THE PREVENTION AND MANAGEMENT OF HEALTHCARE-ASSOCIATED INFECTIONS
Changing population of hospital patients
Increased severity of illness Increased numbers of immunocompromised patients Shorter duration of hospitalization More and larger intensive care units
Pneumonia: 967 (46.9%) Other lower respiratory tract: 368 (17.8%) Urinary tract: 363 (17.6%) Bloodstream: 247 (12.0%)
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Inactivation of aminoglycosides by acetylation, phosphorylation, and adenylation in drugresistant organisms
Acquired Drug Resistance
➢1. enzymatic inactivation (b-lactams, aminoglyc. chloramph) ➢2. rapid efflux of drug out of cell (tetracyclines, ciprofloxacin)
Plasmid-mediated drug resistance
tetracycline sulfonamide
chloramphenicol aminoglycoside
Problems with Antibiotic resistance
➢ more than 50% of antibiotics used in domestic animals for subtherapeutic effect: breeding ground for resistance
➢3. decreased conversion to active form (isoniazid) ➢4. increased concentration of antagonist/competitor (sulfonamide
resistance with increased PABA synthesis). ➢5. altered amount of receptor (trimethoprim-DHFR amplification) ➢6. altered structure of target to reduce binding (methicillin
➢ “KFC does not purchase poultry treated nontherapeutically with medically important antibiotics.” – Letter to “Keep Antibiotics Working,” August 28, 2002
Drug export systems in Gram +
Acquired Drug Resistance
➢1. enzymatic inactivation (b-lactams, aminoglyc. chloramph) ➢2. rapid efflux of drug out of cell (tetracyclines, ciprofloxacin)
• e.g. sulfonamide resistance if high purines, methionine, thymidine available (such as in an abscess)
• e.g. aminoglycosides not effective in anaerobic environment
resistance, vancomycin resistance, ciprofloxacin res.)
Vancomycin resistance: meபைடு நூலகம்hanism
Vancomycin resistance: mechanism
Resistance can be transferred between bacteria
➢ phage transduction ➢ transposable elements ➢ plasmid transfer during conjugation
• plasmids can contain multiple resistance genes • transfer can occur between non-pathogen and pathogens
Resistance to antibiotics
➢ Intrinsic resistance (examples)
• penG does not enter gram negative bacteria well
why? doesn’t penetrate--ampicillin does
• rifampin doesn’t kill fungi
why? doesn’t get in---weaken barrier with amphotericin and then it does
• isoniazid does not kill bugs that don’t require synthesis of mycolic acids
➢ Environmental resistance
➢ McDonald’s ‘We’ve listened to the concerns, studied the issue, and the bottom line was we thought it was the right thing to do to discontinue the use of [fluoroquinolone antibiotics] in poultry,’ said Walt Riker, spokesman for Oak Brook-based McDonald’s. – Walt Riker, McDonald’s, “Chickens Fed With Antibiotics McGone,” Chicago Sun-Times, February 12, 2002
➢ Acquired Resistance
• genetic changes, plasmids with new genes
Bacteria keep up with big pharma in the b-lactam antibiotic arms race
bacteria can often express more than one b-lactamase
There are 7.5 billion chickens, 292 million turkeys, 109 million cattle and 92 million pigs in the United States.
Antibiotics given to pigs as of 2000