Antimicrobial Stewardship

Difference in acquired v. intrinsic methods of antibiotic resistance?

Intrinsic

•A trait shared universally by bacteria in a given species

•Ex: cell wall permeability; efflux pumps

Acquired

•Horizontal gene transfer

•Self-mutations

•Plasmid gene transfer

Of the acquired resistances – what are the mechanisms of resistance?

•Limiting drug uptake

•Modification of the drug target

•Drug inactivation

•Efflux of a drug

•Alteration of Metabolic Pathway

Five antibiotic mechanisms of action

• Cell wall synthesis inhibitors - B-lactams, Cephalosporins

• Cell membrane depolarization - Lipopeptides

• Protein synthesis inhibition - Aminoglycosides, Tetracyclines

• Nucleic acid synthesis inhibition - Fluoroquinolones

• Metabolic pathway inhibition - Trimethoprim, Sulfonamides

What practices contribute to antimicrobial resistance?

• Increased antimicrobial usage – both human and animal

• Improper antimicrobial prescriptions

• Early discontinuation of therapy

• Sharing of medications

• Poor hygiene and preventative medicine

• Antimicrobials in the food supply

What are strategies that can be implemented to combat antimicrobial resistance?

• Disease Prevention

• Judicious Antibiotic Use

• Combination Products

Sulfas + Trimethoprim

• Antibiotic Additives

Amoxicillin + clavulonic acid

• Regulations of antibiotic use

• New Innovations