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Considerations for minimizing antibiotic resistance:. Analyzing current practice in the context of Pseudomonas aeruginosa resistance patterns Becky Carlson Advisor - Professor Fahringer. Presentation outline. Review of mechanisms of resistance Consequences of antimicrobial resistance
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Considerations for minimizing antibiotic resistance: Analyzing current practice in the context of Pseudomonas aeruginosa resistance patterns Becky Carlson Advisor - Professor Fahringer
Presentation outline • Review of mechanisms of resistance • Consequences of antimicrobial resistance • Analysis of current recommendations for decreasing antimicrobial resistance • Implications for the clinician • Available resources
Review of resistance mechanisms • Definition: Hostile Environment Organism Mutated Organism
Review of resistance mechanisms • Bacterial catabolism of antibiotic • Loss of enzyme • Loss of receptor sensitivity • Efflux pumps • Defensive outer surface structures
Antimicrobial resistance consequences Empiricaltreatment impaired Limited resources NoResources
Antimicrobial resistance consequences • Limited resources 1999 Brazilian study of polymyxin use - IV colistin treatment - 58% of patients responded (25% of those with nosocomial pneumonia) - 27% of patients developed renal insufficiency Quinn JP. Pseudomonas aeruginosa infections in the intensive care unit. Seminars in respiratory and critical care medicine. 2003; 24(1): 61-68.
Current Recommendations • Infection prevention - Ventilator use educational program - 73% reduction in ventilator associated pneumonia with a cycling program - 57% reduction in VAP without the cycling program Warren DK, Hill HA, Merz LR, Kollef MH, Hayden MK, Fraser VJ, and Fridkin SK. Cycling empirical antimicrobial agents to prevent emergence of antimicrobial resistant Gram-negative bacteria among intensive care unit patients. Crit Care Med. 2004, Dec; 32(12): 2450-2456.
Current Recommendations • Initial effective treatment - MIC vs MLC – benefits and disadvantages - More research on direct relationship between failed treatment and resistance development
Current Recommendations • Antibiotic control - Cycling programs - Self-resistance Demonstrated correlations between use of beta-lactams and fluoroquinolones and development of resistance Quinn JP. Pseudomonas aeruginosa infections in the intensive care unit. Seminars in respiratory and critical care medicine. 2003; 24(1): 61-68, Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with B-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002; 46(9): 2920-2925, Karlowsky JA, Draghi DC, Jones ME, Thornsberry C, Friedland IR, and Sahm DF. Surveillance for antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii from hospitalized patients in the United States, 1998 to 2001. Antimicrob Agents Chemother. 2003, May; 47(5): 1681-1688.
Current Recommendations • Antibiotic control, continued - Cross-resistance Fluoroquinolones gentamicin, ceftazidime, imipenem, amikacin1 Imipenem ceftazidime, piperacillin- tazobactam2 1. Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, and Quinn JP. Antibiotic resistance among Gram-negative bacilli in US intensive care units. JAMA. 2003, Feb 19; 289(7): 885-888 2. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with B-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002; 46(9): 2920-2925.
Current Recommendations • Transmission prevention http://www.cdc.gov/drugresistance/healthcare/ha/12steps-HA.htm
Implications for the Clinician • Be selective • Consider the broader consequences • Consider this as a current problem, not merely a future problem • Pay attention to local surveillance data
Resources • CDC • Infectious Diseases Society of America http://www.journals.uchicago.edu/IDSA/guidelines/ • Owens RC, Ambrose PG, Nightingale CH, editors. Antibiotic optimization: concepts and strategies in clinical practice. New York: Marcus Dekker; 2005.
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