Module 9.10 Part B

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Antibiotic susceptibility and resistance :

Antibiotic susceptibility and resistance Module 9.10 Part B

Examples of resistance problems:

Examples of resistance problems

MRSA:

MRSA

PowerPoint Presentation:

Emergence of MRSA Wegener, 2006

Cephalosporin-resistant E. coli from bacteraemias:

Cephalosporin-resistant E. coli from bacteraemias An explosive increase recorded since start of 21 st century In the UK, c. 25,000 cases E. coli bacteraemia p.a. c. 10% CTX and/or CAZ resistance = c. 2500 cases p.a. http://www.earss.nivm.nl . 2001 2008 2010

Clonal spread of CTX-M-15-producing E. coli in the UK:

Strain A Clonal spread of CTX-M-15-producing E. coli in the UK Strains B, C, D, E + others ST131

ST131 UK epidemic strain A: Multi-resistance on one plasmid:

Antibiotic classes Genes Mechanism Aminoglycosides aac6’-Ib-cr aad A5 Modify drug β-lactams bla CTX-M-15 bla OXA-1 bla TEM-1 Destroy drug Chloramphenicol catB4 Modify drug Macrolides mph (A) Efflux Fluoroquinolones aac6’-Ib-cr Modify drug Sulfonamides sul I By-pass Trimethoprim dhfr XVII By-pass Tetracycline tet( A) Efflux ST131 UK epidemic strain A: Multi-resistance on one plasmid Woodford, Carattoli et al. AAC

Salmonella and antimicrobial resistance:

Salmonella and antimicrobial resistance Canadian Integrated Program for Antimicrobial Resistance Surveillance, CIPARS (=NARMS)

Salmonella and antimicrobial resistance:

Salmonella and antimicrobial resistance Resistance is increasing generally Multi-drug resistance (MDR) common in some serovars, strains “Integron” mediated, ACSSuT phenotype MDR in serovars Typhimurium (DT104), Newport, Heidelberg, Kentucky Plasmid-mediated AmpC-based bla CMY-2 resistance to 3 rd generation cephalosporins

Total number Salmonella isolated from human blood, CIPARS 2005:

Total number Salmonella isolated from human blood, CIPARS 2005

Chicken abattoir Salmonella isolates, CIPARS 2005:

Chicken abattoir Salmonella isolates, CIPARS 2005

% ceftiofur resistant Heidelberg humans and retail chicken, CIPARS 2007:

% ceftiofur resistant Heidelberg humans and retail chicken, CIPARS 2007

World Health Organization:

World Health Organization Antimicrobial resistance is a global crisis Needs global approach to developing more prudent use

PowerPoint Presentation:

Pre-licensing evaluation including consideration for resistance Prescription only for all antimicrobials used for disease control National systems to monitor antimicrobial usage in food animals Monitoring of resistance and timely corrective actions Guidelines for veterinarians to reduce overuse and misuse Termination or rapid phasing out of antimicrobial growth promoters

Health Canada 2002 Committee recommendations:

Health Canada 2002 Committee recommendations Integrated surveillance; “thresholds” of resistance for action post-introduction Develop a logical “framework” for assessment All AM use prescription only Remove growth promoters if impact human health Promote prudent use 41 recommendations

Development of veterinary prudent use guidelines:

Development of veterinary prudent use guidelines

Generic prudent use guidelines:

Generic prudent use guidelines Use antibiotic only if infection known or suspected Use a narrow spectrum antimicrobial Use susceptibility testing Use for as short a time as possible Ensure compliance Use only under veterinary prescription or endorsement, VCPR

Generic prudent use guidelines:

Generic prudent use guidelines Don’t use “last resort” human drugs Avoid extra-label use Not a substitute for….. Practice infection control Growth promoters …

Antibiotic resistance is complex:

Antibiotic resistance is complex But it’s also simple

Complex problems need multiple solutions:

Complex problems need multiple solutions People have to work together to solve them

:

Antimicrobial Resistance issue is the medical equivalent of Global Warming – it is a global problem requiring concerted efforts particularly reduction by all users of antimicrobials Rebecca Irwin, PHAC

Climate change analogy to resistance:

Climate change analogy to resistance Accumulated over time Multiple reasons Increasing at a rapid pace Potential to be self-sustaining Potential to be catastrophic

Stabilizing climate change:

Stabilizing climate change Idea of “stabilization wedges” We possess the scientific, technical and industrial knowledge to solve the climate and carbon problem No single “wedge” will do this Cumulative effect of 15 will

Stabilizing climate change:

Stabilizing climate change Concept of stabilization wedges: No single “wedge” will reverse Cumulative effect of 15 will

An ABC of antimicrobial stewardship wedges?:

An ABC of antimicrobial stewardship wedges? A ttitudes, B ehaviors, C hoice, D ose, E ducation, F arming, G rowth promoters, H igh-health status, I nfection control, L aboratory diagnosis, J udicious , K nowledge-based, L aboratory diagnosis, M icrobiology, O versight, P harmacology, Q uarantine, R egulation, S urveillance, T ime of use, U se restriction, V accines, W orld surveillance, XY (involves everyone) , Z oning

Stewardship is everyone’s responsibility:

Stewardship is everyone’s responsibility

What do we need?:

What do we need? Continuous improvement by addressing the multiple aspects that stand in the way of optimal antibiotic use Many steps of different sizes; all accept responsibility to improve

Deal with problems as they occur:

Deal with problems as they occur Continuous improvement

What does Canada need?:

What does Canada need? Harmonized provincial regulatory policies A federal-provincial group to bring the veterinary regulatory groups together to develop national policy Veterinary drug regulations that address OUI and API National oversight of AMR A goal, and continuous improvement to reach excellence

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