DOCSLIB.ORG

ANTIBIOTICS and RESISTANCE: NEW • I Have Nothing to Disclose

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
ANTIBIOTICS and RESISTANCE: NEW • I Have Nothing to Disclose 7/24/2018 DISCLOSURES ANTIBIOTICS AND RESISTANCE: NEW • I have nothing to disclose. DRUGS TO HELP COMBAT THE PROBLEM Anna-Kathryn Burch, M.D. Medical Director, Pediatric Antimicrobial Stewardship Palmetto Health Children’s Hospital PHUSC CLINICAL CASE CLINICAL CASE • Patient is a 17 year old with history of interstitial nephritis, etiology unknown. • In the background…Patient is receiving plasmapheresis and increased immunosuppression • required a cadaveric renal transplant at MUSC 7/2/14 • thymoglobulin, rituximab and abatacept per peds Nephrology • Patient was doing well until March 2018 when she began to experience kidney • 3/15-3/30/18: Urosepsis #1 with ESBL E.coli., Blood and Urine culture positive. rejection • Tx x 10 days with Ertapenem after clearing blood culture. • Kidney Bx 3/9/18 for pathology to prove GVHD • 4/4-4/17/18: Urosepsis #2 with ESBL E.coli (stable susceptibilities), blood and urine • Oh by the way, she admits she quit taking her immunosuppressive drugs after the culture positive. biopsy proved she was in rejection. • Patient had a PICU stay. • Patient had large hematoma in the bladder s/p kidney biopsy. • 4/4 ECHO neg, 4/8 RUS neg, 4/9 thoracic/lumbar MRI neg. • 3/10/18 clot removed via large bore foley • Tx x 14 days with Ertapenem after clearing blood culture. CLINICAL CASE CLINICAL CASE • readmitted 4/20/18 for line placement and plasmapheresis. • 5/29-6/18/18: Patient admitted with fever-dx with ESBL E.coli in urine and • 4/22-5/21/18: Urosepsis #3 with ESBL E.coli (stable susceptibilities), blood culture C.diff colitis. only positive as urine culture unfortunately no performed. • Patient tx with Ertapenem and Fidaxomicin x 14 days. • 4/24 ECHO neg • 5/31 MRI abd/pelvis was negative. • 4/26 MRI abdomen and pelvis showed subtle areas of delayed-diminished • Because ESBL E.coli and C.diff found in stool, patient underwent FMT 6/13/18. enhancement involving mid and lower aspect of left kidney which can be seen in the setting of pyelonephritis. • Repeat urine culture 6/15/18 was negative. • Tx x 4 weeks of IV ertapenem after clearing blood culture. • 6/22/18: Stool culture and stool c.diff s/p FMT performed. Stool is c.diff and ESBL E.coli positive. 1 7/24/2018 CLINICAL CASE ANTIBIOTIC RESISTANCE • 6/24/18: Urosepsis #4 with ESBL E.coli (stable susceptibilities) in blood and urine cultures. • Patient has been started on Ceftazidime/Avibactam for urosepsis and oral vancomycin for c.diff colitis as she is now symptomatic. • WHAT DO YOU DO WITH THIS PATIENT????? ANTIMICROBIAL HISTORY • Ancient Egyptians used honey as a wound dressing • Contains hydrogen peroxide and the stickiness of honey provided a wound dressing • Ancient Serbia: • old bread was pressed on wounds to help prevent infection • many of the molds on the bread contained early, raw forms of penicillin • 1640: • John Parkington wrote about mold's effectiveness as an antibiotic • 1877: • Louis Pasteur determined that cultures of bacillus anthracis specked with penicillium notatum could not easily sustain growth World Health Organization Report on Infectious Diseases, 2000 ANTIMICROBIAL HISTORY WHAT IS ANTIMICROBIAL RESISTANCE? • 1927: • German Gerhard Domagk found that an industrial dye, prontosil rubrum, had antibacterial action against staphylococci and hemolytic streptococci • Ability of organisms to resist the effects of an antimicrobial • Sulfonamide was the first antimicrobial • Organisms change in some way that reduces or eliminates the effectiveness of drugs, • Received Nobel Prize chemicals, or other agents designed to cure or prevent infections • The microbes have a better survival rate • 1928: • continue to multiply causing more harm • British Alexander Fleming observed the antibiotic effects of penicillin • Penicillium notatum had destroyed staphylococcus bacteria in culture • Penicillin was finally isolated in 1939 • early 1940s large scale fermentation processes were developed for the production of penicillin http://www.cdc.gov/drugresistance/community/anitbiotic-resistance-faqs.htm World Health Organization Report on Infectious Diseases, 2000 2 7/24/2018 ANTIMICROBIAL RESISTANCE ANTIMICROBIAL RESISTANCE • Selected Pressure • Susceptible microbes are killed easily with antimicrobials leaving organisms that are resistant • They can then pass on their resistance genes • Replication • Conjugation • Plasmids carrying the genes jump from one organism to another • “This process is a natural, unstoppable phenomenon exacerbated by the abuse, overuse and misuse of antimicrobials in the treatment of human illness and in animal husbandry, aquaculture and agriculture.” World Health Organization Report on Infectious Diseases, 2000 ANTIMICROBIAL RESISTANCE ANTIMICROBIAL RESISTANCE • Causal associations between antimicrobial use and the • Abuse, Overuse and Misuse of “… the microbes are educated to resist Antimicrobials penicillin and a host of penicillin-fast emergence of antimicrobial resistance • Increase in drug-resistant organisms organisms is bred out… In such cases the • Changes in antimicrobial use are paralleled by changes in prevalence of resistance • Primary cause is repeated and improper uses thoughtless person playing with penicillin is of antimicrobials morally responsible for the death of the • Increased pressure on physicians inevitably leads to "defensive" and unnecessary prescribing as a means of man who finally succumbs to infection with forestalling potential complications the penicillin-resistant organisms. I hope Fluoroquinolone Use • In North America it is estimated that physicians in both this evil can be averted.” Canada and the United States over-prescribe antibiotics by and Resistance Rates in PSA and Gram- 50% - Sir Alexander Fleming, NY Times June 1945 Negative Bacilli Neuhauser, M. M. et al. JAMA 2003 World Health Organization Report on Infectious Diseases, 2000 Dellit TH et al. CID 2007 ANTIMICROBIAL RESISTANCE ANTIMICROBIAL RESISTANCE • Causal associations between antimicrobial use and the emergence of • There is an association between development of antimicrobial resistance and antimicrobial resistance (cont) mortality • Resistance is more prevalent in health care-associated bacterial infections • Cosgrove et al CID 2003: Meta-analysis • Patients with health care-associated infections caused by resistant strains are • Patients with MRSA bacteremia had an increased risk of mortality compared to more likely than control patients to have prior antibiotic exposure patients with MSSA bacteremia • Areas within hospitals with the highest rates of antimicrobial resistance also have the highest rates of antimicrobial use • Increased length of exposure to antimicrobials increases the likelihood of colonization with resistant organisms 3 7/24/2018 ANTIMICROBIAL DEVELOPMENT VS. FEWER DRUGS CREATED TO COMBAT RESISTANCE ANTIBIOTIC RESISTANCE 1st case MRSA reported 1961 WHAT ARE WE DOING ABOUT NEW DRUGS 2014-2017 RESISTANCE Drug Indications Approval Date Dalbavancin (Dalvance®) ABSSSI May 2014 Tedizolid (Sivextro®) ABSSSI June 2014 Oritavancin (Orbactiv®) ABSSSI August 2014 Ceftolozane/Tazobactam cUTI, cIAI December 2014 (Zerbaxa®) Ceftazidime/Avibactam cUTI, cIAI February 2015 (Avycaz®) Bezlotoxumab (Zinplava®) C.difficile Infection October 2016 Delafloxacin (Baxdela®) ABSSSI June 2017 Meropenem/Vaborbactam cUTI September 2017 (Vabomere®) Plazomicin (Zemdri®) cUTI June 2018 NEW GRAM-POSITIVE AGENTS DALBAVANCIN (DALVANCE®) • Dalbavancin (Lipoglycopeptide – think long acting Vancomycin) • Lipoglycopeptide • Oritavancin (Lipoglycopeptide – think long acting Vancomycin) • Mechanism of Action • Tedizolid (Oxazolidinone – think Linezolid like) • Inhibits cross-linking of peptidoglycans • Delafloxacin (Fluoroquinolone – think ciprofloxacin like) • Destabilizes cell wall, causing cell death • Concentration dependent, bactericidal • FDA approved indications: acute bacterial skin and skin structure infections (ABSSSI) Roberts KD, et al. Pharmacotherapy 2015;35(10):935-948 4 7/24/2018 DALBAVANCIN (DALVANCE®) DALBAVANCIN (DALVANCE®) • ABSSSI recommended Adult dose: • Pediatric Dosing: • Single-dose regimen: • phase 1, open-label, multicenter study to investigate the pharmacokinetics (PK) and safety of a single dose of intravenous dalbavancin in hospitalized pediatric subjects 3 months to 11 years of age • 1500mg IV x 1 dose • the following age-dependent dosing regimen was found to achieve similar dalbavancin exposure to that in adults • Two-dose regimen: administered a 2-dose regimen: • 1000mg IV day 1, followed by 500mg IV day 8 • 6 to <18 years of age, 12 mg/kg (1000 mg maximum) on day 1, 6 mg/kg (500 mg maximum) on day 8 • Effective half-life: 8.5 hours • 3 months to <6 years of age, 15 mg/kg (1000 mg maximum) on day 1, 7.5 mg/kg (500 mg maximum) on day 8 • No dose adjustment necessary with hemodialysis • following age-dependent regimen was found to match adult exposure after a single-dose (1500 mg): • No adjustment for mild liver dysfunction • 6 to <18 years of age, 18 mg/kg (1500 mg maximum) on day 1 • Infused over 30 minutes • 3 months to <6 years of age, 22.5 mg/kg (1500 mg maximum) on day 1 • Cost around $4500/course • No home health, No PICC line Roberts KD, et al. Pharmacotherapy 2015;35(10):935-948 Pediatr Infect Dis J. 2017 Jul;36(7):645-653. ORITAVANCIN (ORBACTIV®) ORITAVANCIN (ORBACTIV®) • Lipoglycopeptide • ABSSSI recommended adult dose: • Multiple Mechanisms of Action • 1200 mg IV once • Inhibits cross-linking of peptidoglycans • Terminal half-life: 8-10 days • Destabilizes cell wall, causing cell death • No adjustment
Load more

Recommended publications
  • Criteria for Use of Dalbavancin for Acute Bacterial Skin/Soft Tissue Infection (Abssti)
    Criteria for Use of Dalbavancin for Acute Bacterial Skin/Soft Tissue Infection (abSSTI) 1. Patients meeting any of the following are NOT ELIGIBLE for dalbavancin therapy: a. History of hypersensitivity reaction to lipoglycopeptide antibiotics (vancomycin, televancin, dalbavancin, oritavancin). b. Patients with acute bacterial skin or skin structure infections such as superficial/simple cellulitis/erysipelas, impetiginous lesion, furuncle, or simple abscess that only requires surgical drainage for cure. c. Infection thought to be caused by gram-negative bacteria d. Infection due to an organism suspected or known to be resistant to dalbavancin or vancomycin 2. For outpatient use (i.e. ED) a. Contact infectious disease for authorization: ABX approval pager (see ON-CALL schedule) b. The following clinical criteria must be met: i. Pre-antibiotic blood cultures must be drawn. ii. Clinical condition expected to require ≥ 24 hours of IV antibiotics – must not qualify for oral antibiotic therapy. iii. Presence of cellulitis, major abscess or a wound infection associated with at least 75cm2 of erythema highly suspected or known to be caused by gram-positive bacteria. iv. The size of the infection must be clearly documented and/or outlined prior to leaving the ED, preferably with a photograph. v. Patient to be discharged to home ± home health (not to skilled nursing facility). c. Required follow up must be set up prior to leaving the ED: i. Must document patient contact info for follow up, preferably reliable cell phone number. ii. Must have follow up within 48-72H with Dr. Turnipseed (916-765-0196) or Rominski. 1. Email patient name, MRN, and phone number.
    [Show full text]
  • Evaluation of Pharmacodynamic Interactions Between Telavancin
    Infect Dis Ther DOI 10.1007/s40121-016-0121-2 ORIGINAL RESEARCH Evaluation of Pharmacodynamic Interactions Between Telavancin and Aztreonam or Piperacillin/ Tazobactam Against Pseudomonas aeruginosa, Escherichia coli and Methicillin-Resistant Staphylococcus aureus Juwon Yim . Jordan R. Smith . Katie E. Barber . Jessica A. Hallesy . Michael J. Rybak Received: May 2, 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com ABSTRACT Methods: In vitro one-compartment PK/PD models were run over 96 h simulating TLV Introduction: In clinical trials comparing 10 mg/kg every 48 h, ATM 500 mg every 8 h telavancin (TLV) with vancomycin for and PTZ continuous infusion 13.5 g over 24 h treatment of hospital-acquired pneumonia, alone and in combination against P. aeruginosa, TLV demonstrated lower clinical cure rates E. coli and methicillin-resistant S. aureus than vancomycin in patients who had mixed (MRSA). The efficacy of antimicrobials was gram-positive and -negative infections and were evaluated by plotting time-kill curves and concomitantly treated with either aztreonam calculating the reduction in log10 cfu/ml over (ATM) or piperacillin/tazobactam (PTZ). Here, 96 h. we investigated therapeutic interactions Results: Against both MRSA strains, TLV was between TLV and ATM or PTZ in an in vitro rapidly bactericidal at 4 h and maintained its pharmacokinetic/pharmacodynamic (PK/PD) activity over 96 h with no observed antagonism model under simulated reduced renal function by either ATM or PTZ. PTZ maintained conditions. bacteriostatic and bactericidal activities against Enhanced content To view enhanced content for this E. coli ATCC 25922 and clinical strain R1022 at article go to http://www.medengine.com/Redeem/ 96 h, whereas both strains regrew as soon as 22E4F0603737CC9F.
    [Show full text]
  • Prospects for New Antibiotics: a Molecule-Centered Perspective
    The Journal of Antibiotics (2014) 67, 7–22 & 2014 Japan Antibiotics Research Association All rights reserved 0021-8820/14 www.nature.com/ja REVIEW ARTICLE Prospects for new antibiotics: a molecule-centered perspective Christopher T Walsh and Timothy A Wencewicz There is a continuous need for iterative cycles of antibiotic discovery and development to deal with the selection of resistant pathogens that emerge as therapeutic application of an antibiotic becomes widespread. A short golden age of antibiotic discovery from nature followed by a subsequent golden half century of medicinal chemistry optimization of existing molecular scaffolds emphasizes the need for new antibiotic molecular frameworks. We bring a molecule-centered perspective to the questions of where will new scaffolds come from, when will chemogenetic approaches yield useful new antibiotics and what existing bacterial targets merit contemporary re-examination. The Journal of Antibiotics (2014) 67, 7–22; doi:10.1038/ja.2013.49; published online 12 June 2013 Keywords: antibiotics; mechanism of action; natural products; resistance A PERSONAL PATHWAY TO ANTIBIOTICS RESEARCH chemical logic and molecular machinery and, in part, with the hope For one of us (CTW), a career-long interest in antibiotics1 was that one might learn to reprogram natural antibiotic assembly lines to spurred by discussions on the mechanism of action of engineer improved molecular variants. D-fluoroalanine2,3 during a seminar visit, as a second year assistant We have subsequently deciphered many of the rules
    [Show full text]
  • Strategies in Stewardship and Why Some Antimicrobials Should Be Protected
    Strategies in Stewardship and Why Some Antimicrobials Should Be Protected Matt Crotty, PharmD Clinical Pharmacist – Infectious Diseases Methodist Dallas Medical Center September 7, 2017 Disclosures • Acted as a consultant – Nabriva Therapeutics AG – Theravance Biopharma Objectives • Define antimicrobial stewardship • Discuss current and future strategies for antimicrobial stewardship to promote judicious use of antimicrobials • Describe the reasons for “protecting” antimicrobials Outline • The Problem • Antimicrobial stewardship – Concept – Strategies • Passive • Active • Other (…prevention would be nice) • Reasons antimicrobials are protected • Collaboration Misuse adversely impacts patients – Resistance “…. the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out… In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted.” - Sir Alexander Fleming, June 1945 Nature Reviews: Drug Discovery. 2007: 6; 8-12. Antibiotics are misused in hospitals . An estimated 30-50% of antimicrobial use in hospitals is inappropriate . Misused in a variety of ways • Given when not needed • Continued when no longer necessary • Wrong dose/drug for infection • Broad spectrum for susceptible organisms IDSA Statement on ‘Antibiotic Resistance: Promoting Critically Needed Antibiotic Research and Development and Appropriate Use (“Stewardship”) of these Precious Drugs’ -Before the House Committee on Energy and Commerce Subcommittee on Health; June 9, 2010 Antibiotics are misused in hospitals CDC, MMWR. 2014; 63. Misuse adversely impacts patients – Adverse Effects . Perception that there is (almost) no risk and (almost) all benefit to giving an antibiotic . Antibiotics account for nearly 1 in 5 (19.3%) of drug-related adverse events • >140,000 ED visits/year • Admission required for 6.1% of adverse events .
    [Show full text]
  • Outpatient Parenteral Antimicrobial Therapy for Infectious Diseases 3Ed
    Outpatient Parenteral Antimicrobial Therapy Handbook of For Infectious Diseases 3ed The Sponsored by Medicines Company ©2016 CRG Publishing, a Division of The Curry Rockefeller Group, LLC, and the Infectious Diseases Society of America All rights reserved. No part of the OPAT eHandbook may be reproduced in any form by any means (eg, electronically, mechanically, copied, recorded, or otherwise), or utilized by any information storage or retrieval system, without the written permission of CRG Publishing and the Infectious Diseases Society of America. For information, contact Rights and Permissions Coordinator, The Curry Rockefeller Group, Suite 410, 660 White Plains Road, Tarrytown, New York, 10591, USA. The Sponsored by Medicines Company Supported by Handbook of Outpatient Parenteral Antimicrobial Therapy For Infectious Diseases 3ed Akshay B. Shah, MD, MBA, FIDSA Anne H. Norris, MD Chair, OPAT Workgroup of IDSA Co-Chair, OPAT Guidelines Committee of IDSA Metro Infectious Disease Consultants Associate Professor of Medicine Editors Clinical Assistant Professor Perelman School of Medicine, University of Pennsylvania Wayne State University Philadelphia, PA Detroit, MI CRG PUBLISHING, A DIVISION OF THE CURRY ROCKEFELLER GROUP, LLC Geneve M. Allison, MD, MSc, FACP Ajay Mathur, MD, FACP Akshay B. Shah, MD, MBA, FIDSA Assistant Professor Regional VP Chair, OPAT Workgroup of IDSA Tufts University School of Medicine ID Care Metro Infectious Disease Consultants Clinical Assistant Professor Antonio C. Arrieta, MD David S. McKinsey, MD Wayne State University Division Chief, Infectious Diseases Physician Children’s Hospital of Orange County Infectious Disease Associates of Kansas City Nabin Shrestha, MD, MPH, FACP, FIDSA Infectious Disease Physician Kavita P. Bhavan, MD Sandra B.
    [Show full text]
  • Prospects for New Antibiotics: a Molecule-Centered Perspective
    The Journal of Antibiotics (2014) 67, 7–22 & 2014 Japan Antibiotics Research Association All rights reserved 0021-8820/14 www.nature.com/ja REVIEW ARTICLE Prospects for new antibiotics: a molecule-centered perspective Christopher T Walsh and Timothy A Wencewicz There is a continuous need for iterative cycles of antibiotic discovery and development to deal with the selection of resistant pathogens that emerge as therapeutic application of an antibiotic becomes widespread. A short golden age of antibiotic discovery from nature followed by a subsequent golden half century of medicinal chemistry optimization of existing molecular scaffolds emphasizes the need for new antibiotic molecular frameworks. We bring a molecule-centered perspective to the questions of where will new scaffolds come from, when will chemogenetic approaches yield useful new antibiotics and what existing bacterial targets merit contemporary re-examination. The Journal of Antibiotics (2014) 67, 7–22; doi:10.1038/ja.2013.49; published online 12 June 2013 Keywords: antibiotics; mechanism of action; natural products; resistance A PERSONAL PATHWAY TO ANTIBIOTICS RESEARCH chemical logic and molecular machinery and, in part, with the hope For one of us (CTW), a career-long interest in antibiotics1 was that one might learn to reprogram natural antibiotic assembly lines to spurred by discussions on the mechanism of action of engineer improved molecular variants. D-fluoroalanine2,3 during a seminar visit, as a second year assistant We have subsequently deciphered many of the rules
    [Show full text]
  • N-Thiolated Β-Lactams: Chemistry and Biology of a Novel Class of Antimicrobial Agents for MRSA Timothy E
    University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 11-18-2003 N-Thiolated β-Lactams: Chemistry and Biology of a Novel Class of Antimicrobial Agents for MRSA Timothy E. Long University of South Florida Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the American Studies Commons Scholar Commons Citation Long, Timothy E., "N-Thiolated β-Lactams: Chemistry and Biology of a Novel Class of Antimicrobial Agents for MRSA" (2003). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/1420 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. N-Thiolated β-Lactams: Chemistry and Biology of a Novel Class of Antimicrobial Agents for MRSA by Timothy E. Long A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Chemistry College of Arts and Science University of South Florida Major Professor: Edward Turos, Ph.D Daniel V. Lim, Ph.D. David Merkler, Ph.D. Gregory Baker, Ph.D. Date of Approval: November 18, 2003 Keywords: Staphylococcus, Antibiotic, Mode of Action, SAR, Drug-Resistance © Copyright 2003, Timothy E. Long ACKNOWLEDGEMENTS The completion of this research would not have been possible without the assistance and guidance of many people with in the Departments of Chemistry and Biology at the University of South Florida. First and foremost, I am grateful to my research advisor, Professor Edward Turos, who has taught me the art of organic synthesis and the importance of reading the literature.
    [Show full text]
  • Antibiotics Currently in Clinical Development
    A data table from Feb 2014 Antibiotics Currently in Clinical Development As of February 2014, there are at least 45 new antibiotics1 with the potential to treat serious bacterial infections in clinical development for the U.S. market. The success rate for drug development is low; at best, only 1 in 5 candidates that enter human testing will be approved for patients.* This snapshot of the antibiotic pipeline will be updated periodically as products advance or are known to drop out of development. Please contact Rachel Zetts at [email protected] or 202-540-6557 with additions or updates. Cited for Potential Development Known QIDP4 Drug Name Company Drug Class Activity Against Gram- Potential Indication(s)5 Phase2 Designation? Negative Pathogens?3 New Drug Application Acute bacterial skin and skin structure Oritavancin The Medicines Company Glycopeptide Yes (NDA) submitted infections New Drug Application Acute bacterial skin and skin structure Dalbavancin Durata Therapeutics Lipoglycopeptide Yes (NDA) submitted infections NDA submitted (for Acute bacterial skin and skin structure acute bacterial skin infections, hospital acquired bacterial Tedizolid Cubist Pharmaceuticals Oxazolidinone Yes and skin structure pneumonia/ventilator acquired bacterial infection indication) pneumonia ACHN-975 Phase 1 Achaogen LpxC inhibitor Yes Bacterial infections Acute bacterial skin and skin structure infections6, methicillin-resistant Fabl inhibitor (AFN-1252 AFN-1720 Phase 1 Affinium Pharmaceuticals Staphylococcus aureus (MRSA) pulmonary pro-drug) infections
    [Show full text]
  • Antibiotic Update
    3/5/2015 Disclosure Antibiotic Update • I do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this Ashley Gustafson, Pharm.D., BCPS continuing education activity, or any affiliation PGY-2 Critical Care Pharmacy Resident with an organization whose philosophy could potentially bias my presentation Baptist Hospital of Miami Pharmacist Objectives Technician Objectives • Review antimicrobial resistance patterns • Recognize new antimicrobial agents and their appropriate use in infectious disease • Assess new antimicrobial agents and their appropriate indications • Discuss what is new in the antimicrobial pipeline • Discuss what is new in the antimicrobial pipeline • Explain why antimicrobial stewardship is • Explain why antimicrobial stewardship is important important Antibiotic Resistance Threats Antibiotic Resistance Variable Microbes Humans Factor “The microbes are educated to resist penicillin ...… In such No. on earth 5 x 10 31 6 x 10 9 ~ 10 22 cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to Mass, metric ton 5 x 10 16 3 x 10 8 ~ 10 8 infection with the penicillin-resistant organism. I hope this evil 5 can be averted.” Generation time 30 min 30 years ~ 5 x 10 - Sir Alexander Fleming 1945 Time on earth, 3.5 x 10 9 4 x 10 6 ~ 10 3 years Spellberg B et al. CID 2008;46:155-64 1 3/5/2015 Antibiotic Resistance Antibiotic Pressure • Existed before antibiotics • Caused by 4 general mechanisms –
    [Show full text]
  • Skin, Skin Structure, and Soft Tissue Infection Diagnosis and Treatment – Adult – Inpatient/Ambulatory Clinical Practice Guideline
    Skin, Skin Structure, and Soft Tissue Infection Diagnosis and Treatment – Adult – Inpatient/Ambulatory Clinical Practice Guideline Note: Active Table of Contents – Click to follow link Table of Contents EXECUTIVE SUMMARY ........................................................................................................... 3 SCOPE ...................................................................................................................................... 4 METHODOLOGY ...................................................................................................................... 4 DEFINITIONS ............................................................................................................................ 5 INTRODUCTION ....................................................................................................................... 6 RECOMMENDATIONS .............................................................................................................. 6 TABLE 1. ANTIMICROBIAL AGENTS DIRECTED AT STREPTOCOCCUS SPP. .................. 9 TABLE 2. ANTIMICROBIAL AGENTS DIRECTED AT STREPTOCOCCUS SPP. AND MSSA9 TABLE 3. ANTIMICROBIAL AGENTS DIRECTED AT STREPTOCOCCUS SPP., MSSA, AND MRSA .......................................................................................................................................10 TABLE 4. ANTIMICROBIAL AGENTS DIRECTED AT STREPTOCOCCUS SPP., MSSA, MRSA, AND GRAM-NEGATIVES ............................................................................................10
    [Show full text]
  • Antibiotic Prescribing – Quality Indicators
    Clinical Microbiology and Infection, Volume 12, Supplement 4, 2006 Antibiotic prescribing – quality indicators P1460 Methods: Medical records from all patients with positive blood Is self-medication with antibiotics in Europe cultures in 2001 were analysed retrospectively. Factors driven by prescribed use? predisposing to infections, results of blood cultures, antibiotic use, and outcome were recorded. L. Grigoryan, F.M. Haaijer-Ruskamp, J.G.M. Burgerhof, Results: The antibiotic use in 226 episodes of true bacteraemia J.E. Degener, R. Deschepper, D. Monnet, A. Di Matteo, were analysed. According to guidelines empirical antibiotic ˚ and the SAR E.A. Scicluna, A. Bara, C. Stalsby Lundborg, J. Birkin treatment should be adjusted in 166 episodes. Antibiotic use was group adjusted in 146 (88%) of these 166 episodes, which led to a Objectives: The occurrence of self-medication with antibiotics narrowing of therapy in 118 (80%) episodes. Compared to has been described in the US and Europe, a possible empirical therapy there was a 22% reduction in the number of contributing factor to increased antibiotic resistance. An antibiotics. Adjustment of therapy was more often performed in important reason for using self-medication can be past Gram-negative bacteraemia and polymicrobial cultures than in experience with antibiotics prescribed by health professionals. Gram-positive bacteraemia. In bacteraemia caused by We investigated whether self-medication in Europe follows the ampicillin-resistant E. coli, ampicillin was mostly replaced by same pattern as prescribed use. ciprofloxacin. The cost for 7 days adjusted therapy was 19800 Methods: A population survey was conducted in: North and EUR (23%) less than for 7 days of empirical therapy.
    [Show full text]
  • Visão De Futuro Para Produção De Antibióticos: Tendências De Pesquisa, Desenvolvimento E Inovação
    UNIVERSIDADE FEDERAL DO RIO DE JANEIRO CRISTINA D’URSO DE SOUZA MENDES SANTOS VISÃO DE FUTURO PARA PRODUÇÃO DE ANTIBIÓTICOS: TENDÊNCIAS DE PESQUISA, DESENVOLVIMENTO E INOVAÇÃO Rio de Janeiro EQ/UFRJ 2014 CRISTINA D ’U RSO DE SOUZA MENDES SANTOS VISÃO DE FUTURO PARA A PRODUÇÃO DE ANTIBIÓTICOS: TENDÊNCIAS DE PESQUISA, DESENVOLVIMENTO E INOVAÇÃO Tese de Doutorado apresentada ao Programa de Pós-Graduação em Tecnologia de Processos Químicos e Bioquímicos, Escola de Química, Universidade Federal do Rio de Janeiro, como requisito parcial à obtenção do título de Doutor em Ciências, D.Sc. Orientadora: Profa. Adelaide Maria de Souza Antunes, D.Sc. Rio de Janeiro 2014 Santos, Cristina d’Urso de Souza Mendes. Visão de futuro para produção de antibióticos: tendências de pesquisa, desenvolvimento e inovação / Cristina d’Urso de Souza Mendes Santos. - Rio de Janeiro, 2014. 216 f.: il.; 29,7 cm. Tese (Doutorado em Ciências) – Universidade Federal do Rio de Janeiro, Escola de Química, Programa de Pós-Graduação em Tecnologia de Processos Químicos e Bioquímicos, Rio de Janeiro, 2014. Orientadora: Adelaide Maria de Souza Antunes. 1. Antibióticos. 2. P&D na Indústria Farmacêutica. 3. Prospecção Tecnológica. 4. Patentes. I. Antunes, Adelaide Maria de Souza. II. Universidade Federal do Rio de Janeiro. Escola de Química. III. Visão de futuro para a produção de antibióticos: tendências de pesquisa, desenvolvimento e inovação. iv v Dedico esta tese à minha mãe querida e amada, que está no céu comemorando esta vitória, que é mais dela do que minha. Dedico também à minha filhinha Malu que sem entender foi a minha maior motivação para concluir esta tese.
    [Show full text]