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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,ANTIBIOTIC RESISTANCE,Infectious Disease Epidemiology Section,Office of Public Health,Louisiana Dept of Health&Hospitals,.Your Taxes at Work.,phone:(504)568-5005,fax:(504)568-5006,Brief History of Resistance,Antibiotic Failures are NOT all due to Resistance,Lack of effectiveness in vivo may not be due to bacterial resistance;the antibiotic may,not be able to reach the microorganisms:cannot go through blood brain barrier,be too toxic at doses required to be effective against targeted microorganisms,.,Antibiotics Use Promotes Resistance,Sustained Antibiotic Use Contributes to Resistance,initial 3-month:use of AMI restricted,TOB&GEN unrestricted,then 12 months when AMI was primary aminoglycoside,Muscato JJ1991.An evaluation of the susceptibility patterns of gram-negative organisms isolated in cancer centres with aminoglycoside usage.Journal of Antimicrobial Chemotherapy.27 Suppl C:1-7.,Resistance Seems to Develop Mostly in ICU,Project ICARE (Intensive Care Antibiotic Resistance Epidemiology)by CDC and Emory U SPH to collect data on 8 US hospitals:,For 8/10 pathogens considered,resistance was higher among in hospital isolates,Antibiotic Use in Agriculture Promotes Resistance,Chickens fed tet-feed,In 1 week intestinal flora,entirely tetR organisms,resistant intestinal bacteria in farm members,not in neighbors,within 6months:,farm dwellers:31%weekly fecal samples 80%tetR,neighbors:6.8%,resistant bacteria contained transferable plasmids,selective pressure by tet-feed extends to human beings in contact with chickens and the feed,Levy SB 1976.Changes in intestinal flora of farm personnel after introduction of a tetracycline-supplemented feed on a farm.NEJM295(11):583-8,Bacteria of Concern,CDC ABC program(Active Bacterial Core Surveillance),:,Streptococcus pyogenes(grp A),Streptococcus agalactiae(grp B),Streptococcus pneumoniae,Haemophilus influenzae,Neisseria meningitidis,Enterococci,Listeria monocytogenes,8 species of bacteria=75%of all bacterial isolated,:,Staphylococcus aureus,Enterococcus spp,Haemophilus influenzae,Escherichia coli,Klebsiella spp,Enterobacter spp,Proteus spp,Pseudomonas aeruginosa,Antibiotic Sensitivity Surveillance,NO comprehensive surveillance system in USA or world,best data:NNIS sensitivity of NI,4%of bacterias ID in USA,ID journals report AB resistance,large literature on resistance,impression resistance growing,for many hospitals,antibiotic susceptibility patterns not very different now than 10 years ago,Sensitivity of Some Bacteria,Streptococcus pneumoniae,NCCLS defined,susceptible MIC 0.06,intermediate0.12 MIC 2.0,penicillin effective on bacteria classified as resistant,for CSF,penicillin not effective,25-50%,DRSP in Louisiana,Active surveillance for DRSP,1997-1999:21%,2000:42%,2001:48%,Passive system:,Region 1 had the highest rate in 2000,39.5/100,000,Laboratory Surveillance,OPH laboratory-based ab resistance surveillance,Select bacterial pathogens,Staphylococcus species with reduced susceptibility or with intermediate resistance to,vancomycin,Haemophilus,Influenzae,Neisseria,meningitidis,enteric pathogens:,Salmonella(10%total sample size),Shigella,(20%total sample size),Campylobacter(25%total sample size),ONLY isolates from invasive disease or sterile site,Send to OPH Laboratory,OPH participates in the National Antimicrobial Resistance Monitoring System(NARMS)by submitting every 10,th,non-,typhoidal,Salmonella isolate and one Campylobacter isolate per week to CDC for susceptibility testing.,Louisiana Antibiogram,Antibiotic Use,Antibiotic Use:Hospital,ICARE phase 2 project,antibiotic use:Defined Daily Dose(DDD)/1,000 patient days,wide variation in antibiotic use according to hospitals,Antibiotic Use:MD Office,USA:antimicrobials 2,nd,most common drugs rx by office based physicians after CNS drugs,1992:110 million oral antimicrobial rx written by office based physicians,annual antimicrobial drug use rate,=439/1,000 population/year,highest rate for children(15)=625/1,000,1980-1992:no major changes in antibiotics utilization rate,Antibiotic Resistance Common among Upper respiratory tract Pathogens,DRSP 25%Multi resistance,Moraxella75%,lactamase producing,H.influenzae25%,lactamase producing,Prevention,1-Vaccinate,Influenza vaccine,S.pneumoniae vaccine,7 vaccine serotypes are also most resistant,So vaccine reduces incidence of infections due to the 7 serotypes and incidence of resistant strains,3-Treat infection,not contamination,Blood cultures,Use proper antisepsis for blood cultures,Avoid culturing vascular catheter tips,Avoid culturing through temporary vascular catheters,4-Treat infection,not colonization,Treat pneumonia,not the tracheal aspirate,not endotracheal tube,Treat urinary tract infection,not the indwelling catheter,not simple,bacteriuria,Treat,bacteremia,not the catheter tip or hub,Treat bone infection,not the skin flora,Guidelines,PEDIATRICS,January 1998,Volume
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