II. Epidemiology
- Health Care Associated Infections are caused by multidrug resistant organisms in 16% of cases (especially MRSA)
III. Pathophysiology: Factors Affecting Drug Resistance
-
Antibiotic Overuse
- Viral Upper Respiratory Infections
- Agricultural Antibiotic use
- Increasing Incidence of Immunocompromised patients
- Food supply globalization
IV. Mechanisms: Beta-Lactamase
- Beta-Lactams (Penicillins and Cephalosporins) inhibit transpeptidase
- Transpeptidase cross-links peptidoglycan mesh in the synthesis of the Bacterial cell wall
- Beta-Lactams inhibition of Transpeptidase results in lysis and death of the Bacterial cell
- Beta-Lactams are inactivated by the enzyme Beta-Lactamase
- Beta-Lactamase is produced by beta-lactam resistant Bacteria
- Several Antibiotics have since been developed to be resistant to Beta-Lactamase
- Beta-Lactamase Resistant Penicillins include Dicloxacillin and Nafcillin
V. Causes: Emerging Drug Resistance
- Methicillin Resistant Staphylococcus Aureus (MRSA)
- Penicillin Resistant Pneumococcus
- Vancomycin Resistant Enterococcus (VRE)
- Multi-resistant Gram Negative Bacilli
- ESBL-Producing Enterobacteriaceae
- Carbapenem-Resistant Enterobacteriaceae (CRE)
- Carbapenem-Resistant Klebsiella
- AmpC Beta-Lactamase-Producing Enterobacteriaceae (typically respond to Cefepime)
- Enterobacter cloacae
- Klebsiella aerogenes
- Citrobacter freundii
- Pseudomonas aeruginosa resistance
- Nosocomial outbreaks
- Restricted drug use sometimes beneficial
- Multi-Resistant Neisseria Gonorrhea
- Multi-Resistant Tuberculosis
-
Carbapenem-Resistant Acinetobacter Baumannii
- Lung and Wound Infections or colonization
- Treated with high dose Unasyn (>= 6g sulbactam) AND Minocycline, Tigecycline or polymyxin B
- May be sensitive to Cefiderocol
- Stenotrophomonas maltophilia
- Lung and Wound Infections in Immunocompromised patients (esp. Hematologic Malignancy)
- Treated with two of the following: TMP-SMZ, Minocycline, Tigecycline, cifiderocol, Levofloxacin
- Alternatively treated with Ceftazidime-Avibactam AND Aztreonam
VI. Prevention
-
Antibiotic Stewardship
- Limit Antibiotics to cases in which they are absolutely indicated
- Prevent spread
- See Health Care-Associated Infection
- See Personal Protection Equipment
- Practice good Hand Hygiene before and after seeing each paint
- Follow contact precautions for colonized or infected patients
- Consider culturing for nasal MRSA in high risk hospital settings (e.g. ICU) and decolonization with Bactroban of infected patients
- Decolonization
- Chlorhexidine baths daily for Intensive Care unit patients (esp. MRSA, VRE patients)
VII. Resources
- Centers for Disease Control
- Patient Education Tools on appropriate Antibiotic use
-
Patient Education from FamilyDoctor.org
- Antibiotic Resistance
- Antibiotic Indications
VIII. Reference
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | An enzyme that brings about the hydrolysis of a beta-lactam (as penicillin to penicilloic acid); found in most staphylococcus strains that are naturally resistant to penicillin. |
Definition (CSP) | enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. |
Definition (MSH) | Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. |
Concepts | Amino Acid, Peptide, or Protein (T116) , Enzyme (T126) |
MSH | D001618 |
SnomedCT | 79744009 |
LNC | LP20680-2 |
English | beta Lactamase, beta Lactamases, beta-Lactamase, beta-Lactamases, beta-Lactamhydrolase, beta lactam hydrolase, beta-lactamases, beta-Lactamases [Chemical/Ingredient], Beta lactamase, beta lactamases, beta lactamase, beta-lactamase, Beta lactamases, beta-Lactamase (substance), Beta-Lactamase |
German | Beta-Lactamase, Beta-Laktamasen, Beta-Laktamase, Beta-Lactamasen |
Swedish | Betalaktamaser |
Czech | beta-laktamasy |
Finnish | Beetalaktamaasit |
French | bêta-Lactamase, bêta-Lactamases |
Russian | BETA-LAKTAMAZY, БЕТА-ЛАКТАМАЗЫ |
Japanese | ベータ-ラクタマーゼ, β-ラクタマーゼ, ベータラクタマーゼ |
Croatian | BETA-LAKTAMAZE |
Polish | Beta-laktamazy |
Norwegian | Betalaktamaser, Betalaktamase |
Spanish | beta - lactamasa (sustancia), beta - lactamasa, beta-Lactamasas |
Italian | Beta-lattamasi |
Portuguese | beta-Lactamases |
Ontology: Antibiotic Resistance, Microbial (C0949285)
Definition (NCI) | The mechanisms, functions, activities, or processes exhibited by microorganisms, especially bacteria, to resist or to become tolerant to antibiotics. |
Definition (NCI_CDISC) | The mechanisms, functions, activities, or processes exhibited by microorganisms, especially bacteria, to resist or to become tolerant to antibiotics. |
Concepts | Organism Attribute (T032) |
MSH | D004352 |
ICD10 | Z16.20 |
English | Antibiotic Resistance, Resistance, Antibiotic, antibiotic resistance, Resistance to antibiotics NOS, ANTIBIOTIC RESISTANCE, Antibiotic Resistance, Microbial |
Czech | rezistence na antibiotika |
Portuguese | Resistência a Antibióticos, Resistência Microbiana a Antibióticos |
Spanish | Resistencia a Antibióticos, Resistencia Microbiana a Antibióticos |
French | Résistance microbienne aux antibiotiques, Antibiorésistance, Résistance des microbes aux antibiotiques |
German | Antibiotikaresistenz, Antibiotikaresistenz, mikrobielle |
Croatian | OTPORNOST MIKROBA NA ANTIBIOTIKE |
Italian | Resistenza microbica agli antibiotici, Resistenza agli antibiotici |
Dutch | Geneesmiddelenresistentie, microbiële |
Ontology: Antimicrobial Resistance (C1456627)
Concepts | Clinical Attribute (T201) |
English | Antimicrobial Resistance |