containment - lecture 12 - antimicrobial resistance

basic structure bacteria versus virus

• plasmid → genetic material, carry genes. the plasmid can be transferred from one bacteria to another.

• virus much less complex than bacteria

antimicrobial drug resistance

• antimicrobial resistance also happens in nature

• ADR in human and animal pathogen is a result of antimicrobial drug usage. 

• antibacterial, antiviral, antifungal, antiparasitic 

mechanisms of resistance

• genetic mutation

• gaining resistance from other bacteria

beta lactam antibiotics

• e.g. penicilin 

• inhibit synthesis of peptidoglycan by binding to penicillin binding proteins 

• PBPs → 

• bacteria produces enzynes that break down the beta lactam ring -. ANTIBIOTIC can not bind anymore

• changes in membrane permeability (due to mutations) that hinder entrance of antibiotic in bacterial cell 

• ….

beta lactamases

• first described in 1940…

• betwen 50 and 90…

• 80 90…. 

• until today → 900 different beta lactamases (enzymes) 

different antibiotics made to combat MDR

• carbapenemases 

• fluoro.. aminoglyco… cotrimo…. 

• pan resistant → bacteria that are resistant to all these antibiotics 

carbapenemases

• most recent bacterial facet breaks this down

usage of antibiotics

• gives an indication of the extent of the problem (MDR) 

• usage is expressed in the unit; defined daily dosages per 100 patient days 

  • this is in hospital

• some antibiotics used as little as possible to save them → carbapenems / cephhalosporins 

deaths attributable to and associated with bacterial antimicrobial resistance 

• more associated with resistance than attributable to resistance

• happens all across the globe 

• in africa higher statisticsl

  • somertimes due to patients only getting half the course / treatment (because of costs) 

high to low diseases 

• lower respiratory infections 

• BSI 

• intra abdominal 

• UTI 

• TB

access to diagnostics

• glass → Global Antimicrobial Resistance and Use Surveillance System

seasonal variation of antibiotic usage in europe

• more is used

trend of usage of antibiotics

• increase in upper middle income → more access to anitbiotics

• not necessarily higher resistance here

• antibiotic resistance in critical pathogens correlate with antibiotic consumption. however consumption is not the only driver;

• access to diagnosistics for appropriate antibiotic usage. water sanitation and hygiene also very important. In Nl isolation of people with MDR pathogens is very important!!

tragedy of the commons

• need to balance different between individual versus risk for population.

• also called access versus excess

• e.g. in africa antibiotic is used to improve malnutrition → also increases risk of ADR

• e.g. antibiotics in live stock

bad medicine

• pollution in evironment → medical waste thrown in river → drinkwater

how to combat AMR at community level

• commit to comprehensive, financed national plan with accountability