细菌的抗生素耐药(英文PPT)Antibiotic Pressure and Resistance
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细菌耐药性(英文PPT)Antimicrobial Resistance
Levy, S. NEJM 1998; 338 (19):1376-8
Bellevue Hospital - 1913
Rapid Development of Resistance to Newly Introduced Antibacterial Agents
Agent Year of FDA Approval First Reported Resistance
Penicillin
1943
1940
Streptomycin 1947
1947
Tetracycline
1952
1956
Methicillin
1960
1961
Nalidixic acid 1964
1966
Gentamicin
1967
1969
Vancomycin
1972
1987
Cefotaxime
1981
Microbes
Have had 3.5 billion years to adapt to the environment
Have invented both beta-lactam antibiotics and betalactamase enzymes to resist those antibiotics more than 2 billion years ago
Once resistance appears, it is likely to decline slowly if at all (Multi-drug R E. coli in chickens despite the removal of the drug selecting for resistance)
Bellevue Hospital - 1913
Rapid Development of Resistance to Newly Introduced Antibacterial Agents
Agent Year of FDA Approval First Reported Resistance
Penicillin
1943
1940
Streptomycin 1947
1947
Tetracycline
1952
1956
Methicillin
1960
1961
Nalidixic acid 1964
1966
Gentamicin
1967
1969
Vancomycin
1972
1987
Cefotaxime
1981
Microbes
Have had 3.5 billion years to adapt to the environment
Have invented both beta-lactam antibiotics and betalactamase enzymes to resist those antibiotics more than 2 billion years ago
Once resistance appears, it is likely to decline slowly if at all (Multi-drug R E. coli in chickens despite the removal of the drug selecting for resistance)
抗生素耐药的机理(英文PPT)
Antibiotics Part 1
Dr P Gayo Munthali Consultant Microbiologist UHCW Honorary Associate Clinical Professor
University of Warwick
Important mechanisms of resistance to antibiotics
Adverse Effects
Penicillin hypersensitivity – 0.4% to 10 %
– Mild: rash – Severe: anaphylaxis & death
• There is cross-reactivity among all Penicillins • Penicillins and cephalosporins ~5-15% • Penicillins and carbapenems~1% (may be higher)
• Inhibit bacterial endopeptidase and glycosidase enzymes which are involved in cell wall growth
• Time dependent activity
Beta Lactams Against Bacterial Cell Wall
Resistance to ß-Lactams
•Penicillin-Binding Protein (PBP) mediated Resistance •ß-Lactamase •Efflux pumps/loss of porins
Penicillin-Binding Protein (PBP) mediated Resistance
Dr P Gayo Munthali Consultant Microbiologist UHCW Honorary Associate Clinical Professor
University of Warwick
Important mechanisms of resistance to antibiotics
Adverse Effects
Penicillin hypersensitivity – 0.4% to 10 %
– Mild: rash – Severe: anaphylaxis & death
• There is cross-reactivity among all Penicillins • Penicillins and cephalosporins ~5-15% • Penicillins and carbapenems~1% (may be higher)
• Inhibit bacterial endopeptidase and glycosidase enzymes which are involved in cell wall growth
• Time dependent activity
Beta Lactams Against Bacterial Cell Wall
Resistance to ß-Lactams
•Penicillin-Binding Protein (PBP) mediated Resistance •ß-Lactamase •Efflux pumps/loss of porins
Penicillin-Binding Protein (PBP) mediated Resistance
抗菌素与抗菌素耐药(英文PPT)
esistance can be prevented
– Antibiotics should be the last line of defence NOT the first
• Most common infections will get better by themselves through time, bed rest, liquid intake and healthy living.
Discovery
Alexander Fleming in 1928 – He was an extremely messy scientist – Came back from holiday to see a mould growing on his Staphylococcus agar plates – Noticed that the Staphylococcus couldn’t grow anywhere near the mould – The mould prevented bacterial growth!
– These bacteria are now a major threat in our hospitals.
– Antibiotic resistant bacteria include Methicillin Resistant Staphylococcus aureus (MRSA)
Antibiotic Resistance
Miracle Cure?
Overuse of antibiotics can damage our normal/good bacteria.
– Many antibiotics prescribed by the doctor are broad spectrum
– Antibiotics should be the last line of defence NOT the first
• Most common infections will get better by themselves through time, bed rest, liquid intake and healthy living.
Discovery
Alexander Fleming in 1928 – He was an extremely messy scientist – Came back from holiday to see a mould growing on his Staphylococcus agar plates – Noticed that the Staphylococcus couldn’t grow anywhere near the mould – The mould prevented bacterial growth!
– These bacteria are now a major threat in our hospitals.
– Antibiotic resistant bacteria include Methicillin Resistant Staphylococcus aureus (MRSA)
Antibiotic Resistance
Miracle Cure?
Overuse of antibiotics can damage our normal/good bacteria.
– Many antibiotics prescribed by the doctor are broad spectrum
抗生素与耐药基因英文PPTAntibioticsandResistanceGenesin课件
Antibiotics and Resistance Genes in Biosolids
Mary Stromberger Soil Microbiology Department of Soil and Crop Sciences
What are Biosolids?
• Organic, treated solids and semi-solids recovered during wastewater treatment
• Field study: determine the antibioticresistance patterns of indigenous microbial communities in control soils and soils receiving long-term inputs of biosolids
– Determine the effects of selected antibiotics on microbial activity and microbial antibiotic resistance patterns in soil during aerobic incubation
– Determine the long-term effects of biosolids, land applied to field soils, on antibiotic resistance patterns of soil microbial communities.
2.6
SMT
5.2
BDL
BDL
BDL BDL
4.6
SCP
10.6
6.6
6.2
6.9
3.8
Mary Stromberger Soil Microbiology Department of Soil and Crop Sciences
What are Biosolids?
• Organic, treated solids and semi-solids recovered during wastewater treatment
• Field study: determine the antibioticresistance patterns of indigenous microbial communities in control soils and soils receiving long-term inputs of biosolids
– Determine the effects of selected antibiotics on microbial activity and microbial antibiotic resistance patterns in soil during aerobic incubation
– Determine the long-term effects of biosolids, land applied to field soils, on antibiotic resistance patterns of soil microbial communities.
2.6
SMT
5.2
BDL
BDL
BDL BDL
4.6
SCP
10.6
6.6
6.2
6.9
3.8
细菌耐药性(英文PPT)Antimicrobial Resistance
CID 2003;37:503 Nine Russian cities/900 families Inventory of home medicine cabinets revealed - 62 different antibiotics found - 84% of households had antibiotics - 9% of households had injectable antibiotics - 72% had more than two antibiotics - 28% had expired antibiotics
Can affect the rate of spread of bacterial resistance by applying selective pressure via exposure to the thousands of metric tons of antibiotics we have used in patients and livestock over the last half century
Underlying Principles of Antibiotic Resistance
Given sufficient time and drug use, antibiotic resistance will emerge. There are no antibiotics to which resistance has not eventually appeared (PRSP took 25 years)
Resistance is progressively evolving from low levels through intermediate to high levels (Increasing MICs are a marker for future resistance)
Can affect the rate of spread of bacterial resistance by applying selective pressure via exposure to the thousands of metric tons of antibiotics we have used in patients and livestock over the last half century
Underlying Principles of Antibiotic Resistance
Given sufficient time and drug use, antibiotic resistance will emerge. There are no antibiotics to which resistance has not eventually appeared (PRSP took 25 years)
Resistance is progressively evolving from low levels through intermediate to high levels (Increasing MICs are a marker for future resistance)
抗生素与耐药(英文PPT)Antibiotics and Resistance
Questions
????
Antibiotic Resistance is the ability to resist the harmful effects of antibiotics by…
Alteration of target receptor proteins Prevention of entry into the cell Destruction of antibiotic upon entry Association with antibiotic which blocks entry Pump antibiotic out of cell before activation Bypass affected step in the metabolic pathway It is rare for a bacterium to possess more than 1,
Resistance can be prevented by taking all of your prescribed antibiotics, taking multiple antibiotics at one time, and restricting antibiotic use to individuals with weakened immune systems.
Antibiotic Resistance is the ability to resist the harmful effects of antibiotics.
Resistance is acquired through genetic mutation, the ingestion of genetic material for resistance, or continuous exposure to low doses of antibiotics.
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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• This is a normal process speeded up by the overuse and misuse of antibiotics.Bacteria that mutate and are able to resist the aBacteriatha mutate and are able to resist the antibiotics that are meant to kill them.
ntibioti that are meant to kill them.
What is Antibiotic Misuse?
• Taking antibiotics when they are not needed:
– for viral infections
• When needed, taking antibiotics incorrectly:
– Stopping the medicine when you feel better - not finishing the prescription
– Saving antibiotics for a future illness – Sharing or using someone else’s medicine
• Resistance in organisms of low virulence can emerge as important pathogens.
• The development of resistant bacteria has driven pharmaceutical research to develop more potent, broad-spectrum antibiotics.
• Several mechanisms have evolved in bacteria which confer them with antibiotic resistance. These mechanisms can either: 1- chemically modify the antibiotic, render it inactive. 2- Physical removal from the cell, 3-Or modify target site so that it is not recognized by the antibiotic. 4-Prevention of penetration of drug
Antibiotic Selection for Resistant Bacteria
Байду номын сангаас
Antibiotic Resistance in Bacteria
Why is it important?
• Antibiotic resistance has developed in almost all classes of bacteria of pathogenic potential.
Antibiotic Resistance in Bacteria How does it happen ?
• Bacteria can become resistant as a result of genetic mutations; these can be transferred between bacteria.
Antibiotic Resistance in Bacteria
Antibiotic Resistant Bacteria Are:
• Bacteria that mutate and are able to resist the antibiotics that are meant to kill them.
• Under selective pressure of antibiotic exposure, these strains then proliferate.
Mechanisms of Bacterial Resistance : how DO they do it ??
Mechanisms
ntibioti that are meant to kill them.
What is Antibiotic Misuse?
• Taking antibiotics when they are not needed:
– for viral infections
• When needed, taking antibiotics incorrectly:
– Stopping the medicine when you feel better - not finishing the prescription
– Saving antibiotics for a future illness – Sharing or using someone else’s medicine
• Resistance in organisms of low virulence can emerge as important pathogens.
• The development of resistant bacteria has driven pharmaceutical research to develop more potent, broad-spectrum antibiotics.
• Several mechanisms have evolved in bacteria which confer them with antibiotic resistance. These mechanisms can either: 1- chemically modify the antibiotic, render it inactive. 2- Physical removal from the cell, 3-Or modify target site so that it is not recognized by the antibiotic. 4-Prevention of penetration of drug
Antibiotic Selection for Resistant Bacteria
Байду номын сангаас
Antibiotic Resistance in Bacteria
Why is it important?
• Antibiotic resistance has developed in almost all classes of bacteria of pathogenic potential.
Antibiotic Resistance in Bacteria How does it happen ?
• Bacteria can become resistant as a result of genetic mutations; these can be transferred between bacteria.
Antibiotic Resistance in Bacteria
Antibiotic Resistant Bacteria Are:
• Bacteria that mutate and are able to resist the antibiotics that are meant to kill them.
• Under selective pressure of antibiotic exposure, these strains then proliferate.
Mechanisms of Bacterial Resistance : how DO they do it ??
Mechanisms