antimicrobial resistance
DESCRIPTION
Presentation given about multi resistant organisms at the Wirral Community NHS Trust Infection Prevention & Control study dayTRANSCRIPT
Objectives
Give an overview of antimicrobial resistance:
- How bugs become resistant
- Why it matters
- What we can do about it
- Acknowledgements Dr Bharat Patel, Consultant Medical Microbiologist, AMR & HCAI Lead for PHL London
How bugs become resistant…..
Antibiotic Resistance is AncientD’ Costa at el (2011) Nature Vol. 477, Issue 7365
Inactivation EffluxImpermeability
By-pass Altered targetPbps
Resistance mechanisms
A B
1. ᵦ-lactamase2. ESBL3. Carbapenemase
Resistant Strains Rare
xx
Resistant strains dominant
Antimicrobial Exposure
xxxx
xx
xx
xx
Selection for antimicrobial-resistant strains
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
www.cdc.govMultiple resistance carried
New Resistant Bacteria
Mutations
XX
Emergence of Antimicrobial Resistance Susceptible Bacteria
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Resistant Bacteria
Resistance Gene Transfer
www.cdc.gov
Plasmid exchange
ccbcmd.edu
Why it matters…..
Bacteria have been around for 3 billion years - antibiotics for 6 decades
“success and speed of bacterial adaptation”
Bennett P M (2008) Plasmid encoded antibiotic resistance: acquisition and transfer of antibiotic resistance genes in bacteria. British Journal of Pharmacology (2008) 153, S347–S357 www.brjpharmacol.org
Why it matters…..
Humans are walking petri dishes – there are 10 times more bacterial cells in our bodies than human cells
Wenner M (207) Humans Carry more bacterial cells than human ones. Scientific American http://www.scientificamerican.com/article/strange-but-true-humans-carry-more-bacterial-cells-than-human-ones/
Increasing resistance …………
MRSA / GISA / VRSA
GRE
ESBLS
CPE
BSI England, Wales, N. Ireland 2011-12
Antimicrobial Resistance
Antibiotic resistance: Cameron warns of medical 'dark ages‘
BBC News 02/07/2014
CMO Professor Dame Sally C. Davies – first annual report (2011) published in 2012
What can we do about it?
Be alert – VIM, VRE, IMP, KPC
Share information – transfer and discharge
Get IPC right! – do the basic AND do then well
Protect the use of antibiotics
What can we do about it ?Reduce expectation – make every contact count
Live well – smoking, exercise
Immunisation
IPC – provider & commissioners
Specimen collection
Prevent readmissions
Dispensing – right time, stop dates, challenge
The end…….
www.cidrap.umn.edu