1. Antimicrobial Resistance
Otiti Emmanuel Okirhiot

2. Otiti Emmanuel Okirhiot
Objective
What is antimicrobial resistance?
Why antibacterial resistance is a concern?
How antibacterial work?
Mechanisms of resistance to antibacterial?
Strategies to contain resistance
3/21/2022
Otiti Emmanuel Okirhiot

3. Otiti Emmanuel Okirhiot
3/21/2022
Otiti Emmanuel Okirhiot

4. Otiti Emmanuel Okirhiot
Introduction
Throughout history there has been a continual battle between human beings and multitude of micro-organisms that cause infection and disease
Antibiotic resistance is one of the biggest threats to global health, food security, and development today.
Antibiotic resistance can affect anyone, of any age, in any country.
Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.
3/21/2022
Otiti Emmanuel Okirhiot

5. Antimicrobial Resistance
Loss of efficacy of a given antibiotics to a particular strain. Frequently staphylococcus aureus, pseudomonas, aeruginosus, mycobacterium tuberculosis
Micro-organisms that are not inhibited by usually achievable systemic concentration of an antimicrobial agent with normal dosage schedule and / or fall in the minimum inhibitory concentration (MIC) range. (WHO)
Antibiotic Resistance (DR) = MIC / MCC > Toxic Plasma Concentration
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Otiti Emmanuel Okirhiot

6. Myths of Antibiotic Resistance
Drugs (antibiotics) cause organisms antibiotic resistant
Antibiotic resistant organisms are more virulent
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Otiti Emmanuel Okirhiot

7. Otiti Emmanuel Okirhiot
Truth
Antibiotics select out the resistant strain
Faulty use of antibiotics or widespread use of antibiotics increases the probability of such selection.
Antibiotic resistant strains appear to be more virulent because we cannot kill them or stop their growth.
3/21/2022
Otiti Emmanuel Okirhiot

8. Acquisition of resistance
Mutation
Genetic change that occurs spontaneously
Transfer of gene
Many bacteria contain extra-chromosal genetic material called plasmid in the cytoplasm.
This carry gene which code for resistance. This may take place by:-
Transduction: is transfer through bacteriophy (virus which infect bacteria)
3/21/2022
Otiti Emmanuel Okirhiot

9. Otiti Emmanuel Okirhiot
Transformation:- resistant bacteria release genetic materials into medium which is taken by other bacteria
Conjugation:- most important mode of spread of resistance. The resistant factor (R-factor) is transferred from cell to cell by direct contact through sex pillus or bridge.
3/21/2022
Otiti Emmanuel Okirhiot

10. Why resistance is a concern
Resistant organisms lead to treatment failure
Increased mortality
Resistant bacteria may spread in Community
Low level resistance can go undetected
Added burden on healthcare costs
Threatens to return to pre-antibiotic era
Selection pressure
3/21/2022
Otiti Emmanuel Okirhiot

11. Contributing Factors to Resistance
Production of drug inactivating enzymes.
Common mechanism cause resistance to many bactum antibiotics.
Microbe synthesizes hydrocytic beta lactamases
Changes in receptor structure
Bacteria contain molecules that act as receptors for antimicrobial drugs.
Molecules undergo changes in their structure.
Structural change make microbe less susceptible to the toxic action of antibiotics.
3/21/2022
Otiti Emmanuel Okirhiot

12. Otiti Emmanuel Okirhiot
Changes in drug permeation and transport.
Microbial actions of many drugs depend on their ability to penetrate the cell membranes of micro-organism and effective intracellular concentration.
Organism defense starts in its efficiency of its cell wall.
Development of alternative metabolic pathways.
Bacteria may produce folic acid by alternative metabolic pathways.
3/21/2022
Otiti Emmanuel Okirhiot

13. Predisposing factors antibiotic resistance
Drug related
Environmental Related
Antibiotic resistance
Patient Related
Prescriber Related
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Otiti Emmanuel Okirhiot

14. Environmental factors
Huge populations & overcrowding
Rapid spread by better transport facility
Poor sanitation
Increases community acquired resistance
Ineffective infection control program
Widespread use of antimicrobials in animal husbandry & agriculture & as medicated cleansing product
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Otiti Emmanuel Okirhiot

15. Otiti Emmanuel Okirhiot
Drug related
Over the counter availability of antimicrobials
Counterfeit & substandard drug causing sub-optimal blood concentration
Irritation fixed dose combination of antimicrobials
3/21/2022
Otiti Emmanuel Okirhiot

16. Otiti Emmanuel Okirhiot
Patient related
Poor adherence of dosage regimens
Poverty
Lack of sanitation concept
Lack of education
Self-medication
Misconception
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Otiti Emmanuel Okirhiot

17. Otiti Emmanuel Okirhiot
Prescriber related
Inappropriate use of available drugs
Increased empiric poly-antimicrobial use
Overuse of antibiotics
Inadequate dosing
Lack of current knowledge & training
3/21/2022
Otiti Emmanuel Okirhiot

18. Prevention of Resistance to Antibiotics/Antimicrobial
Containment of resistance is a multi-pronged program
Involve all the stakeholders i.e.
Physicians
Patients
Pharmaceuticals
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Otiti Emmanuel Okirhiot

19. Otiti Emmanuel Okirhiot
Strategies
Using antibiotics only when absolutely needed
Starting with narrow spectrum antibiotics
Limiting use of new drugs
Identify the infective organisms
Define drug sensitivity of the infecting organism
Consider all host factors:- site of infection, ability of drug of choice to penetrate the site of infection
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Otiti Emmanuel Okirhiot

20. Otiti Emmanuel Okirhiot
Use antibiotic combination only when indicated.
Indication for antibiotic combination are;-
To obtain synergy
Treatment of mixed infection
Initial treatment of severe infection
To prevent emergency of resistance
To reduce the adverse effects
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Otiti Emmanuel Okirhiot

21. Individual approaches to combat antimicrobial resistance
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Otiti Emmanuel Okirhiot

22. Otiti Emmanuel Okirhiot
Individuals
Only use antibiotics when prescribed by a certified health professional.
Never demand antibiotics if your health worker says you don’t need them.
Always follow your health worker’s advice when using antibiotics.
Never share or use leftover antibiotics.
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Otiti Emmanuel Okirhiot

23. Otiti Emmanuel Okirhiot
Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practicing safer sex, and keeping vaccinations up to date.
Prepare food hygienically, following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials) and choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.
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Otiti Emmanuel Okirhiot

24. Otiti Emmanuel Okirhiot
Policy makers
Ensure a robust national action plan to tackle antibiotic resistance is in place.
Improve surveillance of antibiotic-resistant infections.
Strengthen policies, programmes, and implementation of infection prevention and control measures.
Regulate and promote the appropriate use and disposal of quality medicines.
Make information available on the impact of antibiotic resistance.
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Otiti Emmanuel Okirhiot

25. Otiti Emmanuel Okirhiot
Health professionals
Prevent infections by ensuring hands, instruments, and environment are clean.
Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
Report antibiotic-resistant infections to surveillance teams.
Talk to patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
Talk to patients about preventing infections (e.g., vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
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Otiti Emmanuel Okirhiot

26. Otiti Emmanuel Okirhiot
Healthcare industry
Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.
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Otiti Emmanuel Okirhiot

27. Otiti Emmanuel Okirhiot
Agriculture sector
Only give antibiotics to animals under veterinary supervision.
Not use antibiotics for growth promotion or to prevent diseases in healthy animals.
Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.
Promote and apply good practices at all steps of production and processing of foods from animal and plant sources.
Improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.
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Otiti Emmanuel Okirhiot

28. Otiti Emmanuel Okirhiot
WHO RESPONSE
To improve awareness and understanding of antimicrobial resistance.
To strengthen surveillance and research.
To reduce the incidence of infection.
To optimize the use of antimicrobial medicines.
To ensure sustainable investment in countering antimicrobial resistance
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Otiti Emmanuel Okirhiot

29. Otiti Emmanuel Okirhiot
Disadvantages of Antibiotic Combination
Risk of toxicity from each agents
Emergency of organism resistant to multiple drugs
Increased cost of therapy
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Otiti Emmanuel Okirhiot

30. Otiti Emmanuel Okirhiot
Chemoprophylaxis
Chemoprophylaxis agent is the use of microbial agents to prevent infection. This is recommended in the following situations;
To protect healthy person e.g. penicillin, a prevention of gonorrhea
To prevent infection in high risk patient e.g. in cancer patient, immunosuppressive agents and patients with AIDs. Antibacterial like penicillin or Cotrimoxazole, quinolone may reduce incidence of bacterial infections
Surgical prophylaxis
Drug should be effective against all organisms that are likely to contaminate the wound
In close contact
Recommended in particularly in children when infectious cases of leprosy or tuberculosis are in close contact
3/21/2022
Otiti Emmanuel Okirhiot

31. Otiti Emmanuel Okirhiot
SUPERINFECTION
Appearance of new infection resulting from use of antimicrobial antibacterial after the normal antimicrobial flora of intestine, respiratory and gastro-intestinal tract. The normal flora contributes to the defense mechanism as follows; - inhibits colonization of pathogenic organism by producing antibacterial substance (bacetrerian)
PROBIOTICS
Are products containing viable pathogenic micro- organisms given orally to alter the intestinal micro-flora.
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Otiti Emmanuel Okirhiot

32. Otiti Emmanuel Okirhiot
..Forever Grateful…
3/21/2022
Otiti Emmanuel Okirhiot